Provider Demographics
NPI:1942288006
Name:GOLDING, DEVON N (MD)
Entity Type:Individual
Prefix:DR
First Name:DEVON
Middle Name:N
Last Name:GOLDING
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 1:3535 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3930
Mailing Address - Country:US
Mailing Address - Phone:314-664-4808
Mailing Address - Fax:314-772-0600
Practice Address - Street 1:3535 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3930
Practice Address - Country:US
Practice Address - Phone:314-664-4808
Practice Address - Fax:314-772-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-08
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2F38207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202210829Medicaid
MOP00306956OtherRAILROAD MEDICARE
MO080154726OtherRAILROAD MEDICARE
A10079Medicare UPIN
MO202210829Medicaid
MO080154726OtherRAILROAD MEDICARE