Provider Demographics
NPI:1356023196
Name:GOLDMAN, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N MICKEY MANTLE BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:OK
Mailing Address - Zip Code:74339-1110
Mailing Address - Country:US
Mailing Address - Phone:918-315-6494
Mailing Address - Fax:
Practice Address - Street 1:304 N MICKEY MANTLE BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:OK
Practice Address - Zip Code:74339-1110
Practice Address - Country:US
Practice Address - Phone:918-253-6548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist