Healthcare Provider Details

I. General information

NPI: 1225080161
Provider Name (Legal Business Name): STEPHEN LEON GOLDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST SUITE 1410
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

PO BOX 50150
BELLEVUE WA
98015-0150
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2300
  • Fax: 206-386-2303
Mailing address:
  • Phone: 425-228-5228
  • Fax: 425-228-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number12620
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: