Provider Demographics
NPI:1124053079
Name:GOLDBERG, STEVEN LEE (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LEE
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 N CALIFORNIA ST STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5533
Mailing Address - Country:US
Mailing Address - Phone:209-948-2001
Mailing Address - Fax:209-948-2836
Practice Address - Street 1:2216 N CALIFORNIA ST STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5533
Practice Address - Country:US
Practice Address - Phone:209-948-2001
Practice Address - Fax:209-948-2836
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27045208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA756023590OtherRAILROAD MEDICARE NUMBER
CA00G270450Medicaid
CA756023590OtherRAILROAD MEDICARE NUMBER
CAA43192Medicare UPIN