MEDICARE: JERALD STEVEN GOLDSTEIN 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	174400000X	Specialist

General Provider Information

NPI Number	:	1770569626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERALD STEVEN GOLDSTEIN MD

Provider Business Mailing Address
First Line	:	8230 WALNUT HILL LN
Second Line	:	STE 300
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-750-5500
Fax Number	:	214-750-5540

Provider Business Practice Location Address
First Line	:	8230 WALNUT HILL LN
Second Line	:	STE 300
City	:	DALLAS
State	:	TX
Zip	:	75231-4469
Country	:	US
Telephone Number	:	214-750-5500
Fax Number	:	214-750-5540

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	08/06/2008

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