Provider Demographics
NPI:1073614095
Name:GOLDSMITH, IVAN LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:LEE
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5375 S FORT APACHE RD
Mailing Address - Street 2:#102-103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7623
Mailing Address - Country:US
Mailing Address - Phone:702-646-9444
Mailing Address - Fax:702-646-9022
Practice Address - Street 1:5375 S FORT APACHE RD
Practice Address - Street 2:#102-103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7623
Practice Address - Country:US
Practice Address - Phone:702-367-0808
Practice Address - Fax:702-367-1339
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2014-08-06
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Provider Licenses
StateLicense IDTaxonomies
NV6116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine