Provider Demographics
NPI:1114740529
Name:GOLD, PAUL JR (CAPRC I)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:GOLD
Suffix:JR
Gender:M
Credentials:CAPRC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-2516
Mailing Address - Country:US
Mailing Address - Phone:469-630-4818
Mailing Address - Fax:
Practice Address - Street 1:1015 ELM ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-2516
Practice Address - Country:US
Practice Address - Phone:469-630-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist