1467440438 NPI number — MR. ALAN STUART GOLDSTEIN MD

Table of content: MR. ALAN STUART GOLDSTEIN MD (NPI 1467440438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467440438 NPI number — MR. ALAN STUART GOLDSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDSTEIN
Provider First Name:
ALAN
Provider Middle Name:
STUART
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467440438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 HEALTH CENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONITA SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34135-8127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-949-1050
Provider Business Mailing Address Fax Number:
239-949-6111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 HEALTH CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESTERO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34135-8127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-949-1050
Provider Business Practice Location Address Fax Number:
239-949-6111
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  ME72181 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 32558 . This is a "BCBS OF FLA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 251262900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com