Provider Demographics
NPI:1225179880
Name:GOLD, DANIEL AUDLEY III (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:AUDLEY
Last Name:GOLD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAN
Other - Middle Name:A
Other - Last Name:GOLD
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:116 E ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29617-7032
Mailing Address - Country:US
Mailing Address - Phone:406-781-6000
Mailing Address - Fax:864-641-3684
Practice Address - Street 1:116 E ROUND HILL RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-7032
Practice Address - Country:US
Practice Address - Phone:406-781-6000
Practice Address - Fax:864-641-3684
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14503207Q00000X
MT10337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E23637Medicare UPIN
MT000084520Medicare ID - Type Unspecified