Provider Demographics
NPI:1083976641
Name:LOUIS D. GOLD, MD, PA
Entity Type:Organization
Organization Name:LOUIS D. GOLD, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDEN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-477-7150
Mailing Address - Street 1:9080 KIMBERLY BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-2862
Mailing Address - Country:US
Mailing Address - Phone:561-477-7150
Mailing Address - Fax:561-477-7161
Practice Address - Street 1:9080 KIMBERLY BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-2862
Practice Address - Country:US
Practice Address - Phone:561-477-7150
Practice Address - Fax:561-477-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME705572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255195100Medicaid
FLB80515OtherUPIN
FLB80515OtherUPIN