Healthcare Provider Details

I. General information

NPI: 1699569582
Provider Name (Legal Business Name): MAX VINCENT GOLDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD STE 3019B
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

615 S NEW BALLAS RD STE 3019B
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-509-5305
  • Fax: 314-251-4454
Mailing address:
  • Phone: 314-509-5305
  • Fax: 314-251-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2025028790
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: