MEDICARE: LAWRENCE GOLDBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD0035408	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114931599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE GOLDBERG MD

Provider Business Mailing Address
First Line	:	6250 KIPPS COLONY CT APT 304
Second Line	:
City	:	GULFPORT
State	:	FL
Zip	:	33707-3983
Country	:	US
Telephone Number	:	727-343-3004
Fax Number	:	727-343-9521

Provider Business Practice Location Address
First Line	:	6950 CENTRAL AVE
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33707-1210
Country	:	US
Telephone Number	:	727-343-3004
Fax Number	:	727-343-9521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	09/26/2022

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