Provider Demographics
NPI:1245649219
Name:DTG ENTERPRISES LLC D/B/A DR GOLD'S OPTIMAL LIVING INSTITUTE
Entity type:Organization
Organization Name:DTG ENTERPRISES LLC D/B/A DR GOLD'S OPTIMAL LIVING INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-226-7630
Mailing Address - Street 1:8870 N HIMES AVE # 329
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-1627
Mailing Address - Country:US
Mailing Address - Phone:813-379-7092
Mailing Address - Fax:
Practice Address - Street 1:8870 N HIMES AVE # 329
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1627
Practice Address - Country:US
Practice Address - Phone:813-379-7092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty