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General NPI Number Information
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NPI Number | 1952396186
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Entity Type | Individual
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Provider Name | MARC ANDREW GOLDBERG MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 2000 S WHEELING AVE SUITE 501
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City | TULSA
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State | OK
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Zip | 74104-5639
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Country | US
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Telephone | 918-584-4433
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Fax | 918-584-4479
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Provider Business Mailing Address
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Address Line | PO BOX 21228
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City | TULSA
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State | OK
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Zip | 74121-1228
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Country | US
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Telephone | 918-584-4433
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Fax | 918-584-4479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 20009
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License Number State | OK
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