Individual
DEBORAH GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(630) 624-1468
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(630) 624-1468
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036152013
IL
207R00000X
Internal Medicine Physician
2015009594
MO
208000000X
Pediatrics Physician
2015009594
MO
208M00000X
Hospitalist Physician
036152013
IL
208M00000X
Hospitalist Physician
Primary
2015009594
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326338849
—
MO
01
—
P01507711
RAILROAD MEDICARE
MO
01
—
P01507980
RAILROAD MEDICARE
MO
Enumeration date
04/18/2011
Last updated
06/09/2022
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