Provider Demographics
NPI:1134255698
Name:GOLDSTEIN, JEFFREY A (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
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 1:3941 J STREET SUITE 450
Mailing Address - Street 2:SACREMENTO GASTROENTEROLOGY
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3941 J STREET SUITE 450
Practice Address - Street 2:SACREMENTO GASTROENTEROLOGY
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-454-0655
Practice Address - Fax:916-454-5702
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2017-10-24
Deactivation Date:2017-07-25
Deactivation Code:
Reactivation Date:2017-10-24
Provider Licenses
StateLicense IDTaxonomies
CAG39151207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7050815Medicaid
CA7050815Medicaid
E99052Medicare UPIN