Basic Information
| Provider Information | |||||||||
| NPI: | 1942492079 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDSTON | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | CLINTON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 NORTH MEDICAL DRIVE EAST | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841322303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015816908 | ||||||||
| FaxNumber: | 8015814135 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 NORTH MEDICAL DRIVE EAST | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841322303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015816908 | ||||||||
| FaxNumber: | 8015814135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 08/14/2007 | ||||||||
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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 | 2081P2900X | 90-182672-1205 | UT | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.