Provider Demographics
NPI:1669818910
Name:GOLD, VANNA STOTTS (DO)
Entity Type:Individual
Prefix:DR
First Name:VANNA
Middle Name:STOTTS
Last Name:GOLD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:VANNA
Other - Middle Name:MARIE
Other - Last Name:STOTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 WEST AVENUE E
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-2623
Mailing Address - Country:US
Mailing Address - Phone:512-556-3621
Mailing Address - Fax:
Practice Address - Street 1:187 PRIVATE ROAD 4060
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550
Practice Address - Country:US
Practice Address - Phone:512-556-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2771207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program