Provider Demographics
NPI:1780877472
Name:GOLDSMITH, COREY ELAM (MD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:ELAM
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 HOLLY HALL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4124
Mailing Address - Country:US
Mailing Address - Phone:713-566-3689
Mailing Address - Fax:713-566-3675
Practice Address - Street 1:2525 HOLLY HALL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4124
Practice Address - Country:US
Practice Address - Phone:713-566-3689
Practice Address - Fax:713-566-3675
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-25
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM72162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188741601Medicaid
TX8K0433Medicare PIN