Provider Demographics
NPI:1053430975
Name:GOLDMAN, PAUL JAY (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAY
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 W ROSEDALE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-7400
Mailing Address - Country:US
Mailing Address - Phone:817-338-1131
Mailing Address - Fax:817-877-1511
Practice Address - Street 1:1650 W ROSEDALE ST STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:817-338-1131
Practice Address - Fax:817-877-1511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8262174400000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083588601Medicaid
TX083588601Medicaid
TX87T873Medicare ID - Type Unspecified