Individual
CRAIG J GOMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G77225
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G772250
BLUE SHIELD
—
05
—
00G772250
—
CA
01
—
00G772250E02
CALOPTIMA
—
01
—
050739CF74284
TRAILBLAZER
—
01
—
050740CF74284
TRAILBLAZER
—
01
—
050741CF74284
TRAILBLAZER
—
01
—
P00300453
RAILROAD MEDICARE
—
Enumeration date
01/10/2006
Last updated
08/15/2008
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