Individual
JACOB A GOLDENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2461
(701) 234-7481
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2461
(701) 234-7481
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
7788
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10266
—
ND
Enumeration date
07/16/2006
Last updated
01/19/2012
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