Provider Demographics
NPI:1104858422
Name:GOLD, JUDITH (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7777 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 1052
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074
Mailing Address - Country:US
Mailing Address - Phone:713-988-8776
Mailing Address - Fax:713-988-8662
Practice Address - Street 1:450 THIS WAY
Practice Address - Street 2:SUITE B
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:979-297-2220
Practice Address - Fax:979-297-3330
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ9058207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
390004959OtherRAILROAD GBA #
0007BJOtherBCBS #
TX122059201Medicaid
0007BJMedicare PIN
G13023Medicare UPIN