Provider Demographics
NPI:1811980980
Name:GOLD, DANIEL M (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:M
Last Name:GOLD
Suffix:
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 1:501 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2024-02-20
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
TXG8855207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1205922572OtherGROUP NPI
TX130224208Medicaid
TX130224208Medicaid
TX8126B9Medicare ID - Type Unspecified