Basic Information
| Provider Information | |||||||||
| NPI: | 1245699446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDMAN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | HOWARD | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 RIVERFRONT BLVD STE 710 | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342058812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417764000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 RIVERSIDE DR E STE 1500 | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342081031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417413338 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2016 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | OS17260 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 5101026195 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 208D00000X | OS17260 | FL | N | Allopathic & Osteopathic Physicians | General Practice | 207X00000X | OS17260 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.