Provider Demographics
NPI:1134169196
Name:GOLDBERG, ROBERT I (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 ALTON RD
Mailing Address - Street 2:AMBULATORY BUILDING, SUITE 2522
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2800
Mailing Address - Country:US
Mailing Address - Phone:305-674-2240
Mailing Address - Fax:305-674-3961
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:AMBULATORY BUILDING, SUITE 2522
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2800
Practice Address - Country:US
Practice Address - Phone:305-674-2240
Practice Address - Fax:305-674-3961
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37012207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066597500Medicaid
FL95927YMedicare ID - Type Unspecified
FL066597500Medicaid