Healthcare Provider Details

I. General information

NPI: 1831235928
Provider Name (Legal Business Name): WILLIAM S GOLDSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MCBRIDE AND SON CENTER DR SUITE 201
CHESTERFIELD MO
63005-1418
US

IV. Provider business mailing address

6 MCBRIDE AND SON CENTER DR SUITE 201
CHESTERFIELD MO
63005-1418
US

V. Phone/Fax

Practice location:
  • Phone: 636-536-0241
  • Fax: 636-536-0930
Mailing address:
  • Phone: 636-536-0241
  • Fax: 636-536-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberMDR6C15
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMDR6C15
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: