Provider Demographics
NPI:1366466294
Name:GOLDEN, MARLA (DO)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:ANN
Other - Last Name:DEPOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6817 SOUTHPOINT PKWY
Mailing Address - Street 2:SUITE 1404
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6282
Mailing Address - Country:US
Mailing Address - Phone:904-260-1070
Mailing Address - Fax:904-260-1170
Practice Address - Street 1:6817 SOUTHPOINT PKWY
Practice Address - Street 2:SUITE 1404
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6282
Practice Address - Country:US
Practice Address - Phone:904-260-1070
Practice Address - Fax:904-260-1170
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5788208VP0000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80365OtherBCBS
FL2811171-00Medicaid
FLE81322Medicare UPIN
FL80365OtherBCBS
FL80365AMedicare PIN