Provider Demographics
NPI:1255301263
Name:GOLDSTEIN, DAVID P (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1515 E 20TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9039
Mailing Address - Country:US
Mailing Address - Phone:505-326-6400
Mailing Address - Fax:505-326-4606
Practice Address - Street 1:2300 E 30TH ST BLDG A
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8991
Practice Address - Country:US
Practice Address - Phone:505-326-6400
Practice Address - Fax:505-326-4606
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM92-58207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA2053Medicaid
NMNM009F03OtherBCBS
NM201003657OtherPRESBYTERIAN HP
AZ258253Medicaid
NM050038343OtherRR MEDICARE
CO91056259Medicaid
UTT0786Medicaid
NM10001998OtherLOVELACE HP
NMNM009F03OtherBCBS