Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 7108 | AZ |
NPI | 1104920123 |
---|---|
Provider Name | Dr. Gerald Bruce Goldstein |
First Address | Tucson, AZ 85712-2151 |
Second Address | Tucson, AZ 85712-2151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 08/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203175 | (05) | AZ |
D43978 | (02) | AZ |