MR. ETAI GOLDENBERG (NPI# 1669663605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669663605 |
| Entity Type | Individual |
| Full Name | MR. ETAI GOLDENBERG |
| Credential | MD |
| Practice Address |
12855 N. Forty Dr. Ste 375 St. Louis MO 63141 |
| Practice Telephone | 3145676071 |
| Mailing Telephone | 3145676071 |
| Mailing Fax Number | 3145673321 |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2014-10-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 2013013914 | MO | Allopathic & Osteopathic Physicians |
| N | 208800000X | Urology | 264698 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
12855 N. FORTY DR. STE 375 |
| City | ST. LOUIS |
| State | MO |
| Zip Code | 63141 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699810507 | Travis L Bullock | Urology | 12855 N. Forty Dr., Ste 375, St. Louis, MO 63141 | 2007-02-20 |
| 1790802429 | Elizabeth Reichert Williams | Urology | 12855 N. Forty Dr., Ste 375, St. Louis, MO 63141 | 2007-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679102842 | Noor Ramadan | Pharmacist | 628 North New Ballad Road, Suite A, Creve Coeur, MO 63141 | 2020-04-08 |
| 1497381206 | Washington University | Durable Medical Equipment & Medical Supplies | 1044 North Mason Road, Suite 110/210, St. Louis, MO 63141 | 2020-03-13 |
| 1154956498 | Ashleigh Clendenny | Physician Assistant | Mercy Hospital St. Louis, 615 S New Ballas Rd, St. Louis, MO 63141 | 2020-03-06 |
| 1801429410 | Emili Lou Haley | Registered Nurse | 650 Maryville Drive, St Louis, MO 63141 | 2020-02-21 |
| 1629553110 | Rebecca Kathleen Pike | Social Worker | West County Psychological Associates, 12125 Woodcrest Executive Drive #110, St. Louis, MO 63141 | 2018-10-01 |
| 1649756099 | River City Sedation Associates, LLC | Nurse Anesthetist, Certified Registered | 12855 N 40 Dr Ste 150, Saint Louis, MO 63141 | 2018-07-18 |
| 1205333952 | Ear Care and Hearing of St. Louis | Hearing Aid Equipment | 11630 Studt Ave Ste 210, Creve Coeur, MO 63141 | 2018-04-10 |
| 1659897486 | Erin Goodman | Physical Therapist | 10560 Old Olive St. Rd, Suite 100, Creve Coeur, MO 63141 | 2017-08-14 |
| 1093230450 | Center for Urologic Surgery LLC | Clinic/Center | 12855 N 40 Dr Ste 100, Saint Louis, MO 63141 | 2017-08-07 |
| 1871016105 | Jacob Farley Tanner | Specialist/Technologist | 1054 Town and Four Parkway Dr, Creve Coeur, MO 63141 | 2017-07-19 |
| Find all providers in zip 63141 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699810507 | Travis L Bullock | Urology | 12855 N. Forty Dr., Ste 375, St. Louis, MO 63141 | 2007-02-20 |
| 1790802429 | Elizabeth Reichert Williams | Urology | 12855 N. Forty Dr., Ste 375, St. Louis, MO 63141 | 2007-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225699408 | Garth Sherman | Urology | 1 Hospital Dr # Mc301, Columbia, MO 65201-5276 | 2019-06-27 |
| 1902326622 | Alexander Anderson | Urology | 1 Hospital Drive University of Missouri Mc404, Columbia, MO 65212-0001 | 2017-06-23 |
| 1649633736 | Jack Campbell | Urology | 3101 Belinda Ct, Columbia, MO 65203-3848 | 2016-04-05 |
| 1962834390 | Midwest Urology Center, PC | Urology | 1905 W 32nd St Ste 302, Joplin, MO 64804-1512 | 2013-08-08 |
| 1932463940 | Brandi Dawn Miller | Urology | 1965 S Fremont Ave Ste 370, Springfield, MO 65804-2284 | 2012-06-25 |
| 1437412582 | Andrew T Blackburne | Urology | 11155 Dunn Rd Ste 309e, Saint Louis, MO 63136 | 2012-06-22 |
| 1699049395 | Harry L. Ellis | Urology | 5034 S Glenhaven Ave, Springfield, MO 65804-7804 | 2012-02-28 |
| 1083902852 | Gurdarshan S Sandhu | Urology | 607 South New Ballas Road, Suite 3100, Saint Louis, MO 63141 | 2011-07-14 |
| 1457672446 | Christopher D Jaeger | Urology | 112 Piper Hill Dr Ste 12, Saint Peters, MO 63376-1690 | 2010-06-14 |
| 1538486816 | Centerpoint Medical Specialists LLC | Urology | 725 Nw State Route 7, Suite C, Blue Springs, MO 64014-2426 | 2010-04-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.