Provider Demographics
NPI:1407849508
Name:GOLD, JAY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:C
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S INTERNATIONAL PARKWAY
Mailing Address - Street 2:SUITE 2021
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1411
Mailing Address - Country:US
Mailing Address - Phone:407-324-0484
Mailing Address - Fax:407-324-5890
Practice Address - Street 1:1301 S INTERNATIONAL PARKWAY
Practice Address - Street 2:SUITE 2021
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1411
Practice Address - Country:US
Practice Address - Phone:407-324-0484
Practice Address - Fax:407-324-5890
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045710800Medicaid
FL045710800Medicaid
D67210Medicare UPIN