MEDICARE: STEPHANIE GOLDBAUM 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	207Q00000X	Family Medicine Physician	L7395	TX

General Provider Information

NPI Number	:	1922038637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE GOLDBAUM MD

Provider Business Mailing Address
First Line	:	PO BOX 771326
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77215-1326
Country	:	US
Telephone Number	:	713-272-8858
Fax Number	:	713-995-6142

Provider Business Practice Location Address
First Line	:	8278 BELLAIRE BLVD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77036-4090
Country	:	US
Telephone Number	:	713-272-8858
Fax Number	:	713-995-6142

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	11/16/2007

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