Provider Demographics
NPI:1417339920
Name:GOLDSMITH, JUSTIN M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:M
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 N BALLAS RD STE 251C
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2352
Mailing Address - Country:US
Mailing Address - Phone:314-996-3690
Mailing Address - Fax:
Practice Address - Street 1:3009 N BALLAS RD STE 251C
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2352
Practice Address - Country:US
Practice Address - Phone:314-996-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-19
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018013149213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty