Healthcare Provider Details

I. General information

NPI: 1528154614
Provider Name (Legal Business Name): MARTIN GOLDSMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34503 9TH AVE SOUTH #220
FEDERAL WAY WA
98003
US

IV. Provider business mailing address

316 MARTIN LUTHER KING JR WAY #212
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-927-3243
  • Fax: 253-627-0855
Mailing address:
  • Phone: 253-383-5777
  • Fax: 253-627-0855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD00029580
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: