MEDICARE: STEPHEN ALLEN GOLDMAN MD

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	207RC0000X	Cardiovascular Disease Physician	ME33564	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	060063896	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51107	OTHER	FL	BCBS
2	163403	OTHER	FL	WELLCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	225695	OTHER		AVMED

General Provider Information

NPI Number	:	1639119837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN ALLEN GOLDMAN MD

Provider Business Mailing Address
First Line	:	14100 FIVAY ROAD
Second Line	:	SUITE 110
City	:	HUDSON
State	:	FL
Zip	:	34667-7159
Country	:	US
Telephone Number	:	727-849-8771
Fax Number	:	727-842-4962

Provider Business Practice Location Address
First Line	:	6633 FOREST AVE
Second Line	:	302
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-2612
Country	:	US
Telephone Number	:	727-849-8771
Fax Number	:	727-842-4962

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	09/17/2021

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Directions to “ STEPHEN ALLEN GOLDMAN MD” Practice Location

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