Provider Demographics
NPI:1568762979
Name:KEITH R GOLDSTEIN D P M P A
Entity Type:Organization
Organization Name:KEITH R GOLDSTEIN D P M P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:407-509-8852
Mailing Address - Street 1:7634 SPRING BAY CV
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7207
Mailing Address - Country:US
Mailing Address - Phone:407-509-8852
Mailing Address - Fax:407-363-6816
Practice Address - Street 1:7634 SPRING BAY CV
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7207
Practice Address - Country:US
Practice Address - Phone:407-509-8852
Practice Address - Fax:407-363-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 2436213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty