Provider Demographics
NPI:1639119837
Name:GOLDMAN, STEPHEN ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ALLEN
Last Name:GOLDMAN
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 1:14100 FIVAY ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7159
Mailing Address - Country:US
Mailing Address - Phone:727-849-8771
Mailing Address - Fax:727-842-4962
Practice Address - Street 1:6633 FOREST AVE
Practice Address - Street 2:302
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2612
Practice Address - Country:US
Practice Address - Phone:727-849-8771
Practice Address - Fax:727-842-4962
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33564207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51107OtherBCBS
FL163403OtherWELLCARE
060063896OtherRAILROAD MEDICARE
FL039468800Medicaid
225695OtherAVMED
FL51107VMedicare PIN
FL039468800Medicaid
225695OtherAVMED
FLE14473Medicare UPIN