MEDICARE: NOEL D GOLDTHWAITE 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	G45635	CA

General Provider Information

NPI Number	:	1548232903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL D GOLDTHWAITE MD

Provider Business Mailing Address
First Line	:	1850 SULLIVAN AVE
Second Line	:	SUITE 200
City	:	DALY CITY
State	:	CA
Zip	:	94015-2221
Country	:	US
Telephone Number	:	650-985-7500
Fax Number	:	650-985-7511

Provider Business Practice Location Address
First Line	:	455 HICKEY BLVD STE 310
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2630
Country	:	US
Telephone Number	:	650-985-7500
Fax Number	:	650-731-4434

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	04/01/2019

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