Provider Demographics
NPI:1750368528
Name:GOLDMAN, STEPHEN J (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2465 DEWBERRY RDG
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-9116
Mailing Address - Country:US
Mailing Address - Phone:641-856-7833
Mailing Address - Fax:
Practice Address - Street 1:2465 DEWBERRY RDG
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-9116
Practice Address - Country:US
Practice Address - Phone:641-856-7833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2297986Medicaid
IAH66433Medicare UPIN
IAI13009Medicare ID - Type Unspecified