MEDICARE: GORDON GOLDSMITH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	18441	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16D0386507	OTHER		CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205834793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GORDON GOLDSMITH MD

Provider Business Mailing Address
First Line	:	2943 NORTHGATE DRIVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245
Country	:	US
Telephone Number	:	319-338-1197
Fax Number	:	319-337-2199

Provider Business Practice Location Address
First Line	:	2943 NORTHGATE DRIVE
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245
Country	:	US
Telephone Number	:	319-338-1197
Fax Number	:	319-337-2199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	05/23/2008

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