Provider Demographics
NPI:1831291319
Name:GOLDSTEIN, JAY CARL (DPM)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:CARL
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2222 NW LOVEJOY ST
Mailing Address - Street 2:#510
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3033
Mailing Address - Country:US
Mailing Address - Phone:503-221-1581
Mailing Address - Fax:503-221-1582
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:#510
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3033
Practice Address - Country:US
Practice Address - Phone:503-221-1581
Practice Address - Fax:503-221-1582
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2010-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORDP00107213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR15499-7Medicaid
ORT67657Medicare UPIN
OR0833380001Medicare NSC