Provider Demographics
NPI:1619192127
Name:GOLD, JEROME ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ALAN
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEROME
Other - Middle Name:ALAN
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:23441 MADISON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4734
Mailing Address - Country:US
Mailing Address - Phone:310-373-0000
Mailing Address - Fax:310-373-3748
Practice Address - Street 1:23441 MADISON ST STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4734
Practice Address - Country:US
Practice Address - Phone:310-373-0000
Practice Address - Fax:310-373-3748
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG203212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG20321OtherDR GOLD-PHYSICAN LICENSE#
CAW7961BMedicare PIN
CAG20321OtherDR GOLD-PHYSICAN LICENSE#