Individual
RUSSELL S GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13014 120TH AVE NE, KIRKLAND, WA 98034-3015
(425) 821-8004
Mailing address
1100 9TH AVE, MS M4-PA, SEATTLE, WA 98101-2756
(206) 583-6025
(206) 515-5886
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00020625
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039581
LABOR & INDUSTRY
WA
05
—
1109404
—
WA
01
—
GO7787
BLUE SHIELD
WA
01
—
US0900001
AETNA/USHC PCP
WA
Enumeration date
07/25/2006
Last updated
04/14/2011
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