Provider Demographics
NPI:1992895312
Name:GOLDSTEIN, JEFFREY A (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 GILHAM AVENUE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108
Mailing Address - Country:US
Mailing Address - Phone:816-802-1117
Mailing Address - Fax:816-460-1083
Practice Address - Street 1:2401 GILHAM AVENUE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-802-1117
Practice Address - Fax:816-460-1083
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350677022086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ185415Medicaid
AZ185415Medicaid
Z115602Medicare PIN
AZE93884Medicare UPIN