Provider Demographics
NPI:1144550286
Name:GOLDMAN, LAWRENCE JAY (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JAY
Last Name:GOLDMAN
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 1:3172 ANTIGUA BAY LN
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-9224
Mailing Address - Country:US
Mailing Address - Phone:352-343-2414
Mailing Address - Fax:
Practice Address - Street 1:3172 ANTIGUA BAY LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-9224
Practice Address - Country:US
Practice Address - Phone:352-343-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 24822207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology