Provider Demographics
NPI:1366402000
Name:GOLDMAN, LAWRENCE BARTON (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:BARTON
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 1:1776 S JACKSON ST
Mailing Address - Street 2:SUITE 840
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3801
Mailing Address - Country:US
Mailing Address - Phone:303-914-0065
Mailing Address - Fax:303-986-3680
Practice Address - Street 1:1776 S JACKSON ST
Practice Address - Street 2:SUITE 840
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-3801
Practice Address - Country:US
Practice Address - Phone:303-914-0065
Practice Address - Fax:303-986-3680
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28210208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01282102Medicaid
COE05635Medicare UPIN
COC518258Medicare PIN
CO01282102Medicaid