Provider Demographics
NPI:1578522058
Name:GOLD, SCOTT L (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-473-6160
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:1223 GATEWAY DR STE 2G
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-473-6160
Practice Address - Fax:321-725-7028
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME421302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05474UOtherMEDICARE
FL280300300Medicaid
FL4038971OtherAETNA
FL4417092OtherCIGNA
FL05474OtherBCBS OF FL
FL4038971OtherAETNA INS
FLP00434935OtherRR MEDICARE
FL05474WMedicare PIN
FL4038971OtherAETNA INS
FL4038971OtherAETNA