Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME41855 | FL |
NPI | 1013952282 |
---|---|
Provider Name | Mark Goldstein |
First Address | Greenacres, FL 33463-4727 |
Second Address | Atlantis, FL 33462-6608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 03/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D65262 | (02) |