Healthcare Provider Details

I. General information

NPI: 1750368528
Provider Name (Legal Business Name): STEPHEN J GOLDMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 SCENIC VIEW DR SW
ROCHESTER MN
55902-1529
US

IV. Provider business mailing address

2465 DEWBERRY RDG
MUSCATINE IA
52761-9116
US

V. Phone/Fax

Practice location:
  • Phone: 641-856-7833
  • Fax:
Mailing address:
  • Phone: 641-856-7833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3486
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number78637
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: