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NPI Code Detail

MEDICARE: MR. JAMES M GOLDHARDT PA-C

MEDICARE: MR. JAMES M GOLDHARDT PA-C
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
1363AS0400XSurgical Physician Assistant7486AZ
2363A00000XPhysician Assistant8545-23WI

Other Identifiers

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

General Provider Information

NPI Number : 1790347292
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES M GOLDHARDT PA-C
Provider Business Mailing Address
First Line : 2945 S DOBSON RD
Second Line :
City : MESA
State : AZ
Zip : 85202-7941
Country : US
Telephone Number : 480-969-4138
Fax Number : 480-969-0630
Provider Business Practice Location Address
First Line : 1400 S DOBSON RD STE A200
Second Line :
City : MESA
State : AZ
Zip : 85202-4707
Country : US
Telephone Number : 480-969-4138
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2019
Last Update Date : 01/21/2026

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