Provider Demographics
NPI:1891744231
Name:GOLDSTONE, JOEL R (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:R
Last Name:GOLDSTONE
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 1:37000 N GANTZEL RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7303
Mailing Address - Country:US
Mailing Address - Phone:480-394-4248
Mailing Address - Fax:480-394-4718
Practice Address - Street 1:37000 N GANTZEL RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7303
Practice Address - Country:US
Practice Address - Phone:480-394-4248
Practice Address - Fax:480-394-4718
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92707208M00000X
AZ25595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272761700Medicaid
FL272761700Medicaid
U5120AMedicare ID - Type Unspecified
AZZ143620Medicare PIN
AZZ140113Medicare PIN