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General NPI Number Information
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NPI Number | 1992325294
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Entity Type | Individual
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Provider Name | PAUL GOLDSMITH DO
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Gender | Male
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 1771 COMMERCIAL ST
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City | WARSAW
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State | MO
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Zip | 65355-3096
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Country | US
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Telephone | 604-385-1936
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Fax |
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Provider Business Mailing Address
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Address Line | 815 MAIN ST STE A
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City | PEORIA
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State | IL
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Zip | 61602-1080
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Country | US
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Telephone | 309-672-4977
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Fax |
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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 | 036.161746
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2023028662
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License Number State | MO
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