MEDICARE: DR. TERRY JAN GOLDMAN D.P.M.

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	213E00000X	Podiatrist	PO1410	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	:	1902893712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY JAN GOLDMAN D.P.M.

Provider Business Mailing Address
First Line	:	10630 PARIS ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-4817
Country	:	US
Telephone Number	:	305-558-4004
Fax Number	:	954-437-2733

Provider Business Practice Location Address
First Line	:	10630 PARIS ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-4817
Country	:	US
Telephone Number	:	305-558-4004
Fax Number	:	954-437-2733

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	03/12/2009

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