Healthcare Provider Details

I. General information

NPI: 1386031219
Provider Name (Legal Business Name): ROBERT GOLDSTEIN, M.D., PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6703 W RIO GRANDE AVE BLDG A
KENNEWICK WA
99336-2623
US

IV. Provider business mailing address

6703 W RIO GRANDE AVE
KENNEWICK WA
99336-2623
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-9375
  • Fax: 509-763-1503
Mailing address:
  • Phone: 509-946-9375
  • Fax: 509-736-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00039823
License Number StateWA

VIII. Authorized Official

Name: ALISA HOYT
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 509-946-9375