Provider Demographics
NPI:1205922572
Name:DANIEL M GOLD MD PA
Entity type:Organization
Organization Name:DANIEL M GOLD MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-723-3250
Mailing Address - Street 1:501 E KOLSTAD ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-2352
Mailing Address - Country:US
Mailing Address - Phone:903-723-3250
Mailing Address - Fax:903-723-5550
Practice Address - Street 1:501 E KOLSTAD ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-2352
Practice Address - Country:US
Practice Address - Phone:903-723-3250
Practice Address - Fax:903-723-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153837302Medicaid
TX00944TOtherBLUE CROSS BLUE SHIELD #
TX153837302Medicaid