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General NPI Number Information
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NPI Number | 1871787168
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Entity Type | Organization
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Legal Business Name | MATTHEW L GOODSTEIN MDPC
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 1830 BLAKE AVE SUITE 201
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4275
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Country | US
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Telephone | 970-945-1112
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Fax | 970-945-4868
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Provider Business Mailing Address
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Address Line | 1830 BLAKE AVE SUITE 201
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City | GLENWOOD SPRINGS
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State | CO
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Zip | 81601-4275
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Country | US
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Telephone | 970-945-1112
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Fax | 970-945-4868
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Authorized Official
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Title or Position | PRES
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Name | DR. MATTHEW L GOODSTEIN
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Credential | MD
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Telephone | 970-945-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 31599
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License Number State | CO
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