Individual
DR. MARK P GOLDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH. D.
Contact information
Practice address
222 SIDNEY BAKER ST S, SUITE 500, KERRVILLE, TX 78028-5994
(830) 895-7675
(830) 896-9340
Mailing address
PO BOX 291993, KERRVILLE, TX 78029-1993
(830) 895-7675
(830) 896-9340
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
22476
TX
103TC0700X
Clinical Psychologist
22476
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00H51R
BLUE CROSS
TX
01
—
098724001
CHIPS
TX
05
—
098724001
—
TX
Enumeration date
08/29/2006
Last updated
07/09/2010
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