Provider Demographics
NPI:1003892605
Name:GOLDBAS, STEPHEN R (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:GOLDBAS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:195 FORE RIVER PKWY STE 470
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2787
Mailing Address - Country:US
Mailing Address - Phone:207-373-0770
Mailing Address - Fax:207-808-8500
Practice Address - Street 1:195 FORE RIVER PKWY STE 407
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-749-6612
Practice Address - Fax:207-747-4077
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2022-03-14
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Provider Licenses
StateLicense IDTaxonomies
ME1678207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1003892605Medicaid
MEMM9073Medicare PIN
ME1003892605Medicaid
MEF51960Medicare UPIN