Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 2006023557 | MO |
N | 222Z00000X | Podiatrist | 2006023557 | MO |
N | 213E00000X | Podiatrist | MD2185 | NJ |
N | 222Z00000X | Podiatrist | MD2185 | NJ |
Y | 213ES0103X | Foot & Ankle Surgery | 12-00358KS | KS |
NPI | 1003896374 |
---|---|
Provider Name | Dr. Jacob B. Goldstein |
First Address | Gardner, KS 66030-1643 |
Second Address | Gardner, KS 66030-1643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 18/10/2012 |