Provider Demographics
NPI:1215171830
Name:GOLDSTEIN, BRADLEY E (DO, MPH, MS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:E
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DO, MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13785 WALSINGHAM RD # 120
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3221
Mailing Address - Country:US
Mailing Address - Phone:941-727-1243
Mailing Address - Fax:
Practice Address - Street 1:8614 E STATE ROAD 70
Practice Address - Street 2:SUITE 200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3710
Practice Address - Country:US
Practice Address - Phone:941-727-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11318207Q00000X
FLOS 11318207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine