Provider Demographics
NPI:1750310959
Name:GOLD, STEPHANIE PAIGE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:PAIGE
Last Name:GOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3604 S COOPER ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-3481
Mailing Address - Country:US
Mailing Address - Phone:817-466-8008
Mailing Address - Fax:817-466-8131
Practice Address - Street 1:3604 S COOPER ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-3481
Practice Address - Country:US
Practice Address - Phone:817-466-8008
Practice Address - Fax:817-466-8131
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM0414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177653603Medicaid
TX177653603Medicaid
TX8G0790Medicare ID - Type Unspecified