Provider Demographics
NPI:1235278177
Name:JONATHAN A GOLD
Entity Type:Organization
Organization Name:JONATHAN A GOLD
Other - Org Name:MOUNTAIN VIEW WOMENS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-426-0955
Mailing Address - Street 1:2300 KATI CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-1900
Mailing Address - Country:US
Mailing Address - Phone:360-426-0955
Mailing Address - Fax:360-427-1268
Practice Address - Street 1:2300 KATI CT
Practice Address - Street 2:SUITE A
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-1900
Practice Address - Country:US
Practice Address - Phone:360-426-0955
Practice Address - Fax:360-427-1268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA070013310207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7064512Medicaid
WA7064512Medicaid
WA503850Medicare Oscar/Certification