Provider Demographics
NPI:1215152723
Name:GOLDFARB, JUSTIN M (DO)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:M
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5750 W THUNDERBIRD RD
Mailing Address - Street 2:C300
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4660
Mailing Address - Country:US
Mailing Address - Phone:602-938-2848
Mailing Address - Fax:602-938-4401
Practice Address - Street 1:5750 W THUNDERBIRD RD
Practice Address - Street 2:C300
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4660
Practice Address - Country:US
Practice Address - Phone:602-938-2848
Practice Address - Fax:602-938-4401
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-117585207R00000X
TXBP10033466207RX0202X
AZ005668207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-117585OtherIL STATE LIC