Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS11318 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | OS 11318 | FL |
NPI | 1215171830 |
---|---|
Provider Name | Dr. Bradley E Goldstein |
First Address | Largo, FL 33774-3221 |
Second Address | Bradenton, FL 34202-3710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2009 |
Last Update Date | 13/11/2014 |