Provider Demographics
NPI:1578502373
Name:GOLDSTEIN, LON MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:MICHAEL
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 1:7515 GREENVILLE AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3831
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-823-9745
Practice Address - Street 1:3600 GASTON AVE
Practice Address - Street 2:SUITE 1205
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1800
Practice Address - Country:US
Practice Address - Phone:214-826-6021
Practice Address - Fax:214-823-9745
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5392208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117256103Medicaid
80416XOtherBCBS PROVIDER ID
TX340017091OtherRRMCR
80416XOtherBCBS PROVIDER ID
TX117256103Medicaid