Provider Demographics
NPI:1417066044
Name:GOLDMAN, GORDON MELVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:MELVIN
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:226 SOUTH WOODS MILL ROAD
Mailing Address - Street 2:SUITE 60W
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3665
Mailing Address - Country:US
Mailing Address - Phone:314-878-7333
Mailing Address - Fax:314-878-7453
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:SUITE 60W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-878-7333
Practice Address - Fax:314-878-7453
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO30541207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA10856Medicare UPIN