1255490264 NPI number — MR. SCOTT FRANKLIN GOLDBERG PA-C

Table of content: MR. SCOTT FRANKLIN GOLDBERG PA-C (NPI 1255490264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255490264 NPI number — MR. SCOTT FRANKLIN GOLDBERG PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDBERG
Provider First Name:
SCOTT
Provider Middle Name:
FRANKLIN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255490264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 9TH AVE
Provider Second Line Business Mailing Address:
MS:M4-PFS
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98101-2756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-515-5811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 9TH AVE
Provider Second Line Business Practice Location Address:
MS:X6-ORT
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-2756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-223-7530
Provider Business Practice Location Address Fax Number:
206-341-0195
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA17801 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA60801172 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FT721A . This is a "SA MEDICAL PHYSICIANS OF CA PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MEDICAL LICENSE . This is a "PA 17801" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com