1831235928 NPI number — DR. WILLIAM S GOLDSTEIN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831235928 NPI number — DR. WILLIAM S GOLDSTEIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDSTEIN
Provider First Name:
WILLIAM
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1831235928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 MCBRIDE AND SON CENTER DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63005-1418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-536-0241
Provider Business Mailing Address Fax Number:
636-536-0930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 MCBRIDE AND SON CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63005-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-536-0241
Provider Business Practice Location Address Fax Number:
636-536-0930
Provider Enumeration Date:
01/29/2007

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: 202K00000X , with the licence number:  MDR6C15 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: MDR6C15 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7970 . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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