Basic Information
| Provider Information | |||||||||
| NPI: | 1255301263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDSTEIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 E 20TH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874019039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053266400 | ||||||||
| FaxNumber: | 5053264606 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 E 30TH ST BLDG A | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874018991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053266400 | ||||||||
| FaxNumber: | 5053264606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 09/10/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 92-58 | NM | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | A2053 | 05 | NM | MEDICAID | NM009F03 | 01 | NM | BCBS | OTHER | 201003657 | 01 | NM | PRESBYTERIAN HP | OTHER | 258253 | 05 | AZ | MEDICAID | 050038343 | 01 | NM | RR MEDICARE | OTHER | 91056259 | 05 | CO | MEDICAID | T0786 | 05 | UT | MEDICAID | 10001998 | 01 | NM | LOVELACE HP | OTHER |