Provider Demographics
NPI:1932386935
Name:GARY GOLDSTEIN MD PLLC
Entity Type:Organization
Organization Name:GARY GOLDSTEIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-722-5868
Mailing Address - Street 1:PO BOX 32196
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85751-2196
Mailing Address - Country:US
Mailing Address - Phone:520-722-5868
Mailing Address - Fax:520-290-8174
Practice Address - Street 1:1200 N EL DORADO PL
Practice Address - Street 2:SUITE B-240
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4637
Practice Address - Country:US
Practice Address - Phone:520-722-5868
Practice Address - Fax:520-290-8174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18985207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE52307Medicare UPIN
AZZ106472Medicare PIN