Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME112547 | FL |
NPI | 1053353136 |
---|---|
Provider Name | Bradley J Goldstein |
First Address | Miami, FL 33136-2107 |
Second Address | Miami, FL 33136-2107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 15/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0062340-00 | (05) | FL |
431978699 | (05) | ME |
I11023 | (02) | ME |