Provider Demographics
NPI:1689653453
Name:GOLDMAN, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:GOLDMAN
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 1:601 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-625-9575
Mailing Address - Fax:561-625-9533
Practice Address - Street 1:601 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-625-9575
Practice Address - Fax:561-625-9533
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85291207R00000X, 202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
21231237644OtherBEECH STREET
11306611OtherCAQH
FL62685OtherBCBS
7293400OtherAETNA
820556723OtherCIGNA HEALTHCARE
820556723OtherUNITED HEALTHCARE
P00083413OtherPALMETTO MC
FL266708800Medicaid
820556723OtherPRIVATE HEALTHCARE SYSTEM
015061OtherALL PPO
9950OtherDIMENSION HEALTH
P2775296OtherOXFORD HEALTH
7293400OtherAETNA
820556723OtherPRIVATE HEALTHCARE SYSTEM
H69225Medicare UPIN