Provider Demographics
NPI:1770569626
Name:GOLDSTEIN, JERALD STEVEN (MD)
Entity type:Individual
Prefix:
First Name:JERALD
Middle Name:STEVEN
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 WALNUT HILL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4469
Mailing Address - Country:US
Mailing Address - Phone:214-750-5500
Mailing Address - Fax:214-750-5540
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:STE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4469
Practice Address - Country:US
Practice Address - Phone:214-750-5500
Practice Address - Fax:214-750-5540
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70168Medicare UPIN
8F0562Medicare ID - Type Unspecified