DR. MARC VINCENT GOLDHAGEN (NPI# 1730167909) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730167909 |
| Entity Type | Individual |
| Full Name | DR. MARC VINCENT GOLDHAGEN |
| Credential | MD, MPH |
| Practice Address |
2200 Bergquist Drive Ste 1, Attn: Credentials (cmc) Lackland Afb TX 78236-5300 |
| Mailing Address |
1431 Whisper Mtn San Antonio TX 78258-3205 |
| Practice Telephone | 2105366946 |
| Mailing Telephone | 2104555534 |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 2083A0100X |
Preventive Medicine Specialization: Aerospace Medicine |
G77740 | CA | Allopathic & Osteopathic Physicians |
| X | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
G77740 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
2200 BERGQUIST DRIVE STE 1, ATTN: CREDENTIALS (CMC) |
| City | LACKLAND AFB |
| State | TX |
| Zip Code | 78236-5300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427343920 | Alexis Anthon Beauvais | General Practice | 2200 Bergquist Drive, Wilford Hall Medical Center, Lackland Afb, TX 78263-9908 | 2011-06-13 |
| 1023301090 | Stephen Davis Hioe | Student in an Organized Health Care Education/Training Program | 2200 Bergquist Drive, Wilford Hall Medical Center, Lackland Afb, TX 78236-9908 | 2011-05-24 |
| 1073771812 | Dana Lee Klope | Student in an Organized Health Care Education/Training Program | 2200 Bergquist Drive, Suite 1 Whmc/ge, Lackland Afb, TX 78236-9908 | 2008-05-29 |
| 1013174226 | Gayle Denise Haischer-rollo | Pediatrics | 2200 Bergquist Drive, Suite 1, Lackland Afb, TX 78236-9908 | 2008-05-16 |
| 1154543684 | Brian Michael Waters | Psychiatry & Neurology | 2200 Bergquist Drive, Wilford Hall Medical Center, Lackland Afb, TX 78236-5300 | 2007-05-03 |
| 1649497017 | Robert Joseph Love | Psychiatry & Neurology | 2200 Bergquist Drive, Suite 1, Lackland Afb, TX 78236-5300 | 2007-04-19 |
| 1003878158 | Judith Delmar | Internal Medicine | 2200 Bergquist Drive, Suite 1: Attn Credentials (cmc), Lackland Afb, TX 78236-5300 | 2006-04-04 |
| 1558320093 | Scott Barclay Norris | Family Medicine | 2200 Bergquist Drive, Suite 1 Attn: Credentials (cmc), Lackland Afb, TX 78236-5300 | 2006-03-22 |
| 1770561862 | Charles Puls | Anesthesiology | 2200 Bergquist Drive, Attn: Credentials (cmc), Suite 1, Lackland Afb, TX 78236-5300 | 2006-01-09 |
| 1669450870 | Marcus Milo Cranston | Internal Medicine | 2200 Bergquist Drive, Ste 1, Attn: Credentials (cmc), Lackland Afb, TX 78236-5300 | 2006-01-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063047363 | Arnoldo Arturo Gonzalez Jr. | Specialist/Technologist | 1033 Truemper St, Lackland Afb, TX 78236 | 2020-03-06 |
| 1023643343 | Meredith Grace Cockerell | Specialist/Technologist | W Military Drive, San Antonio, TX 78236 | 2020-03-06 |
| 1578120598 | Hali Rashelle Hall | Dentist | 1615 Truemper St, Blg 6418, Attn: 59ds/sgdn, Jbsa Lackland, TX 78236 | 2019-05-24 |
| 1952967077 | Paul Fianza Boseman | Nurse Practitioner | 1106 Wilford Hall Loop, San Antonio, TX 78236 | 2019-05-14 |
| 1689161978 | Kelly Jones Buckshire | Dentist | Dunn Dental Clinic, 1615 Truemper Rd, San Antonio, TX 78236 | 2018-04-23 |
| 1902308570 | Roger Louis Farney | Student in an Organized Health Care Education/Training Program | 1100 Wilford Hall Loop Bldg. 4554, Jbsa Lackland Afb, TX 78236 | 2018-02-28 |
| 1568916856 | Thomas Maxwell Woolf | Dentist | 1100 Wilford Hall Ambulatory Surgical Center, Lackland Afb, TX 78236 | 2016-08-04 |
| 1831544956 | Michael Veronneau | Student in an Organized Health Care Education/Training Program | 59 Mdw/ge 1100 Wilford Hall Loop, Bldg. 4554, Jbsa Lackland, TX 78236 | 2016-04-26 |
| 1376906958 | David Kephart Jr. | General Practice | 1100 Wilford Hall Loop Bldg 4454, Jbsa Lackland, TX 78236 | 2016-04-01 |
| 1184084089 | Olivia Arballo | Dermatology | Wilford Hall Asc, Attn: Dept of Dermatology, 1100 Wilford Hall Loop Bldg 4554, Jbsa-lackland, TX 78236 | 2016-03-04 |
| Find all providers in zip 78236 | ||||
| Taxonomy Code | 2083A0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Aerospace Medicine |
| Aerospace medicine focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles, together with the support personnel who assist operation of such vehicles. This population often works and lives in remote, isolated, extreme, or enclosed environments under conditions of physical and psychological stress. Practitioners strive for an optimal human-machine match in occupational settings rich with environmental hazards and engineering countermeasures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. American Osteopathic Board of Preventive Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407198823 | David Chase Rogers | Preventive Medicine | 1100 Wilfod Hall Loop, Bldg. 4556, Lackland Afb, TX 78236-9908 | 2013-03-24 |
| 1356437537 | Romie N Richardson | Preventive Medicine | 1940 Carswell Ave, Lackland Afb, TX 78236-5514 | 2006-10-05 |
| 1518013127 | Thomas W Travis | Preventive Medicine | 59th Medical Wing, 2200 Bergquist Drive, Suite 1, Lackland Afb, TX 78236-5300 | 2007-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295267573 | Quinn Dufurrena | Preventive Medicine | 301 University Blvd # 1110, Galveston, TX 77555-1110 | 2017-03-28 |
| 1760841423 | Anant Shukla | Preventive Medicine | Mendoza Aviation Clinic (11335 Ssg Sims Blvd), El Paso, TX 79935 | 2016-02-23 |
| 1689069296 | Darryl George Demaris | Preventive Medicine | Texas A&m Hsc Com S&w Hospital, 2401 S. 31st Street - Ms-01-w256, Temple, TX 76508-0001 | 2015-03-31 |
| 1639505951 | Mark Richard Hannay | Preventive Medicine | 614 Mccain St Ste 310, Kingsville, TX 78363 | 2013-09-18 |
| 1326387291 | Skin Institute | Preventive Medicine | 1901 Babcock Rd Ste 200, San Antonio, TX 78229-4545 | 2013-02-12 |
| 1710221742 | Conrad Ivan Dalton | Preventive Medicine | 98 S. Shawnee Ridge Circle, The Woodlands, TX 77382-2555 | 2012-11-15 |
| 1164766358 | Guillermo J. Salazar | Preventive Medicine | 2601 Meacham Blvd, Faa, Asw-300, Fort Worth, TX 76137-4204 | 2012-11-12 |
| 1609149681 | Lucky Lusterio | Preventive Medicine | 221 3rd St. W, Randolph Afb, TX 78150 | 2012-02-21 |
| 1205139367 | Kenneth Edward Cottle | Preventive Medicine | 148 S Bay Dr, Bullard, TX 75757-8929 | 2010-12-13 |
| 1245498922 | Richard Harris Stoller | Preventive Medicine | 13714 Cape Blf, San Antonio, TX 78216-1605 | 2008-05-29 |
| Find all providers with the same taxonomy | ||||
| City | LACKLAND AFB |
| Zip Code | 78236 |
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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.