MEDICARE: JOSH HARRIS GOLDSTRICH M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	2005020560	MO
2	208600000X	Surgery Physician	N0796	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AA853	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1134265580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSH HARRIS GOLDSTRICH M.D.

Provider Business Mailing Address
First Line	:	6600 FISH POND RD 101
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-2582
Country	:	US
Telephone Number	:	254-776-3188
Fax Number	:	254-776-3607

Provider Business Practice Location Address
First Line	:	6600 FISH POND RD STE 101
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-2582
Country	:	US
Telephone Number	:	254-776-3188
Fax Number	:	254-776-3607

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/21/2022

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