Provider Demographics
NPI:1922164789
Name:GOLSTON, ALAN G (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:G
Last Name:GOLSTON
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 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:209 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4265
Practice Address - Country:US
Practice Address - Phone:253-596-3300
Practice Address - Fax:253-596-3713
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025685207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8445538Medicaid
WAGAB26061Medicare PIN
WAD33871Medicare UPIN
WAGAB26060Medicare PIN
WAP00175074Medicare PIN
WA060060478Medicare PIN
WAGAB26059Medicare PIN
WAG001050818Medicare PIN
WA8445538Medicaid
WAG8872341Medicare PIN