Healthcare Provider Details

I. General information

NPI: 1831458652
Provider Name (Legal Business Name): WILLIAM JOSEPH GOLDKAMP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD STE 1200
SAINT LOUIS MO
63141
US

IV. Provider business mailing address

615 S NEW BALLAS RD STE 1200
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-2880
  • Fax:
Mailing address:
  • Phone: 314-251-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2019024473
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: