Provider Demographics
NPI:1740366517
Name:GOLTSCHMAN, JOHN PAUL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:GOLTSCHMAN
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 1:900 N HWY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031
Mailing Address - Country:US
Mailing Address - Phone:314-838-0300
Mailing Address - Fax:314-838-4682
Practice Address - Street 1:900 N HWY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031
Practice Address - Country:US
Practice Address - Phone:314-838-0300
Practice Address - Fax:314-838-4682
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO35266207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10291OtherESSENCE HEALTHCARE
1438823OtherUNITED HEALTHCARE
008203OtherEXCLUSIVE CHOICE FMH BENE
105982OtherMERCY HEALTH PLANS
20496OtherBCBS
5692540002OtherCIGNA
132399OtherEYEMED VISION CARE
33665OtherCOORDINATED VISION CARE
964416OtherAETNA
12464OtherOPTICARE EYE HEALTH NETWO
104596OtherHEALTHLINK
41681OtherGROUP HEALTH PLAN
A11045Medicare UPIN