Individual
DR. JACOB H GOLDBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4571 COLONIAL BLVD, SUITE 210, FORT MYERS, FL 33966-1156
(239) 274-7600
(239) 274-7601
Mailing address
2160 COLONIAL BLVD, PAYER CONTRACTING AND RELATIONS, FORT MYERS, FL 33907-1410
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME 35410
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039133600
—
FL
01
—
1278209
WELLCARE
FL
01
—
7365988
CIGNA PROVIDER #
FL
01
—
95439
BCBS FL PROVIDER #
FL
01
—
P00413910
RAILROAD MEDICARE
FL
Enumeration date
07/11/2005
Last updated
03/21/2017
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