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General NPI Number Information
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NPI Number | 1003892605
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Entity Type | Individual
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Provider Name | STEPHEN R GOLDBAS D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 195 FORE RIVER PKWY STE 407
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City | PORTLAND
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State | ME
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Zip | 04102-2780
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Country | US
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Telephone | 207-749-6612
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Fax | 207-747-4077
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Provider Business Mailing Address
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Address Line | 195 FORE RIVER PKWY STE 470
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City | PORTLAND
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State | ME
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Zip | 04102-2787
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Country | US
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Telephone | 207-373-0770
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Fax | 207-808-8500
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1678
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 1678
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License Number State | ME
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