Provider Demographics
NPI:1548225816
Name:GOLDSMITH, JON R (DPM)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:R
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:
Practice Address - Street 1:6829 N 72ND ST
Practice Address - Street 2:SUITE 7500
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1723
Practice Address - Country:US
Practice Address - Phone:402-933-8540
Practice Address - Fax:402-933-8578
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE304213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026225000Medicaid
NE098684180Medicare PIN