Provider Demographics
NPI:1790338333
Name:LARRY S GOLDSTEIN DPM PC
Entity Type:Organization
Organization Name:LARRY S GOLDSTEIN DPM PC
Other - Org Name:WARNER ROBINS FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:478-328-2008
Mailing Address - Street 1:1200 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5540
Mailing Address - Country:US
Mailing Address - Phone:478-328-2008
Mailing Address - Fax:478-255-4364
Practice Address - Street 1:1200 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5540
Practice Address - Country:US
Practice Address - Phone:478-328-2008
Practice Address - Fax:478-255-4364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty