Provider Demographics
NPI:1487644498
Name:GOLDSTEIN, RANDY J (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:J
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 1:510 CAMINO REAL AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-2006
Mailing Address - Country:US
Mailing Address - Phone:915-521-1529
Mailing Address - Fax:915-521-1472
Practice Address - Street 1:1801 N OREGON ST
Practice Address - Street 2:LAS PALMAS EMERGENCY DEPARTMENT
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3524
Practice Address - Country:US
Practice Address - Phone:915-521-1529
Practice Address - Fax:915-521-1472
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0211207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156505303Medicaid
TXL0211OtherSTATE LICENSE
TX156505301Medicaid
TX8C0849OtherBCBS
NM93309023Medicaid
TXP00323520OtherRAILROAD
TX156505301Medicaid
TX156505303Medicaid
NM93309023Medicaid