1831485903 NPI number — DR. DOUGLAS JOHN GOLDSTEIN DPT

Table of content: DR. DOUGLAS JOHN GOLDSTEIN DPT (NPI 1831485903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831485903 NPI number — DR. DOUGLAS JOHN GOLDSTEIN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDSTEIN
Provider First Name:
DOUGLAS
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1831485903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7310 S ALTON WAY
Provider Second Line Business Mailing Address:
#6L
Provider Business Mailing Address City Name:
CENTENNIAL
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80112-2334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-790-4495
Provider Business Mailing Address Fax Number:
720-488-1988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5801 S QUEBEC ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GREENWOOD VILLAGE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80111-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-770-0870
Provider Business Practice Location Address Fax Number:
303-770-0871
Provider Enumeration Date:
06/27/2011

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: 225100000X , with the licence number:  11266 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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