MEDICARE: DR. RICHARD IAN GOLDBERGER M.D.

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	207XS0117X	Orthopaedic Surgery of the Spine Physician	ME34601	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0624143	OTHER	FL	AETNA
2	04029	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1154317121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD IAN GOLDBERGER M.D.

Provider Business Mailing Address
First Line	:	5106 N ARMENIA AVE
Second Line	:	SUITE 4
City	:	TAMPA
State	:	FL
Zip	:	33603-1433
Country	:	US
Telephone Number	:	813-875-0074
Fax Number	:	813-878-0186

Provider Business Practice Location Address
First Line	:	5106 N ARMENIA AVE
Second Line	:	SUITE 4
City	:	TAMPA
State	:	FL
Zip	:	33603-1433
Country	:	US
Telephone Number	:	813-875-0074
Fax Number	:	813-878-0186

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/08/2007

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