Provider Demographics
NPI:1679651210
Name:GOLDSTEIN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
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:PO BOX 4829
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4829
Mailing Address - Country:US
Mailing Address - Phone:713-464-9621
Mailing Address - Fax:713-464-3284
Practice Address - Street 1:921 GESSNER RD
Practice Address - Street 2:ATTN: ANESTHESIA DEPT
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2501
Practice Address - Country:US
Practice Address - Phone:713-932-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1092207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1388092Medicaid
TX8P2150OtherBC/BS
TXC16215Medicare UPIN
TX8C8211Medicare ID - Type Unspecified