Provider Demographics
NPI:1902893712
Name:GOLDMAN, TERRY JAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JAN
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 PARIS ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4817
Mailing Address - Country:US
Mailing Address - Phone:305-558-4004
Mailing Address - Fax:954-437-2733
Practice Address - Street 1:10630 PARIS ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-4817
Practice Address - Country:US
Practice Address - Phone:305-558-4004
Practice Address - Fax:954-437-2733
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1410213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041362300Medicaid
FL041362300Medicaid
FL87816ZMedicare PIN