Provider Demographics
NPI:1902809502
Name:GOLDBERG, URI Z (DO)
Entity Type:Individual
Prefix:
First Name:URI
Middle Name:Z
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2847
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-2847
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 W HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OR
Practice Address - Zip Code:97391-1242
Practice Address - Country:US
Practice Address - Phone:541-336-5181
Practice Address - Fax:541-336-7614
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO159256207Q00000X
CO41999207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15929353Medicaid
OR500650948Medicaid
CO15929353Medicaid
OR500650948Medicaid