Individual
MR. KENNETH GORDON GOLDABER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
515 W MAYFIELD RD, SUITE 304, ARLINGTON, TX 76014-2083
(817) 467-1010
(817) 419-2626
Mailing address
515 W MAYFIELD RD, SUITE 304, ARLINGTON, TX 76014-2083
(817) 467-1010
(817) 419-2626
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
Primary
H3815
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161496801
—
TX
01
—
27KH
BLUE CROSS BLUE SHIELD
TX
Enumeration date
09/22/2005
Last updated
01/30/2012
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