| Entity Name: | LAWRENCE R. GOLDBERG, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 16 Dec 1985 (39 years ago) |
| Date of dissolution: | 27 Sep 2024 (5 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (5 months ago) |
| Document Number: | H90176 |
| FEI/EIN Number | 59-2616652 |
| Address: | C/O Lawrece R Goldberg, MD, 6950 Central Avenue, Saint Petersburg, FL 33707 |
| Mail Address: | C/O Lawrence R Goldberg, MD, 6250 Kipps Colony Court South, Apt 304, Gulfport, FL 33707 |
| ZIP code: | 33707 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144530379 | 2010-10-21 | 2010-10-21 | 4957 38TH AVE N, SUITE D, SAINT PETERSBURG, FL, 337102174, US | 4957 38TH AVE N, SUITE D, SAINT PETERSBURG, FL, 337102174, US | |||||||||||||||||||||||
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| Phone | +1 727-521-4669 |
Authorized person
| Name | LAWRENCE GOLDBERG |
| Role | OWNER |
| Phone | 7275214669 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 0035408 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 066311500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOLDBERG, LAWRENCE R. | Agent | Lawrence R Goldberg, MD, 6250 Kipps Colony Court South, Apt 304, Gulfport, FL 33707 |
| Name | Role | Address |
|---|---|---|
| GOLDBERG, LAWRENCE R, Dr. | Director | 6250 Kipps Colony Court South, Apt 304 Gulfport, FL 33707 |
| Name | Role | Address |
|---|---|---|
| GOLDBERG, CHARLOTTE | Vice President | 6250 Kipps Colony Court South, Apt 104 Gulfport, FL 33707 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-23 | C/O Lawrece R Goldberg, MD, 6950 Central Avenue, Saint Petersburg, FL 33707 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-23 | C/O Lawrece R Goldberg, MD, 6950 Central Avenue, Saint Petersburg, FL 33707 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-23 | Lawrence R Goldberg, MD, 6250 Kipps Colony Court South, Apt 304, Gulfport, FL 33707 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-21 |
| ANNUAL REPORT | 2015-03-01 |
| ANNUAL REPORT | 2014-01-09 |
Date of last update: 04 Feb 2025
Sources: Florida Department of State
