MEDICARE: STACIA H GOLDEY MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician	ME0058163	FL
2	207W00000X	Ophthalmology Physician	ME0058163	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180018859	OTHER	FL	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1033112156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACIA H GOLDEY MD

Provider Business Mailing Address
First Line	:	148 13TH ST SW
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33770-3127
Country	:	US
Telephone Number	:	727-581-8706
Fax Number	:	727-588-2447

Provider Business Practice Location Address
First Line	:	148 13TH ST SW
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33770-3127
Country	:	US
Telephone Number	:	727-581-8706
Fax Number	:	727-588-2447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/07/2020

148 13TH ST SW STE 200
LARGO, FL
33770-3127

Practice Phone: 727-450-3030
Practice Fax: 727-450-3031