Provider Demographics
NPI:1538232905
Name:GOLDMAN, GERALD DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DONALD
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 1:1866 N ORANGE GROVE #104
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3031
Mailing Address - Country:US
Mailing Address - Phone:909-623-8628
Mailing Address - Fax:909-623-4198
Practice Address - Street 1:1866 N ORANGE GROVE #104
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3031
Practice Address - Country:US
Practice Address - Phone:909-623-8628
Practice Address - Fax:909-623-4198
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38042207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G380420Medicaid
G38042Medicare ID - Type Unspecified
CA00G380420Medicaid