Provider Demographics
NPI:1427020122
Name:GOLDSTEIN, SAMUEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:R
Last Name:GOLDSTEIN
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 1:805 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1636
Mailing Address - Country:US
Mailing Address - Phone:205-939-3699
Mailing Address - Fax:205-581-7155
Practice Address - Street 1:805 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1636
Practice Address - Country:US
Practice Address - Phone:205-939-3699
Practice Address - Fax:205-581-7155
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11500207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL09-10143OtherUNITED HEALTHCARE
AL168252100OtherFEDERAL WORK COMP
AL200039736OtherRAILROAD MEDICARE
AL051522083OtherMEDICARE LEGACY #
AL51114077OtherBLUE CROSS AND BLUE SHIELD
AL000097724OtherMEDICARE LEGACY#
AL128702Medicaid
AL200039736OtherRAILROAD MEDICARE
AL168252100OtherFEDERAL WORK COMP
AL051097724OtherBLUE CROSS BLUE SHIELD
AL000097724OtherMEDICARE LEGACY#
AL529906630Medicaid