Provider Demographics
NPI:1457397135
Name:GOLD, DONALD D JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:D
Last Name:GOLD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 731
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242
Mailing Address - Country:US
Mailing Address - Phone:731-642-4422
Mailing Address - Fax:731-642-0068
Practice Address - Street 1:401 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4821
Practice Address - Country:US
Practice Address - Phone:731-642-4422
Practice Address - Fax:731-642-0068
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY384122084P0800X
TNMD0095802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3723326Medicaid
KY64053168Medicaid
MS09014277Medicaid
TN3184854Medicare PIN
TNP00293762Medicare PIN
KYD32156Medicare UPIN
MS09014277Medicaid