Provider Demographics
NPI:1326125683
Name:GOLDSTON, HERBERT J (MD)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:J
Last Name:GOLDSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4134
Mailing Address - Country:US
Mailing Address - Phone:360-424-8951
Mailing Address - Fax:360-424-8953
Practice Address - Street 1:1315 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4134
Practice Address - Country:US
Practice Address - Phone:360-424-8951
Practice Address - Fax:360-424-8953
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist