Provider Demographics
NPI:1215932058
Name:GOLD, MICHAEL GARY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GARY
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2486 PONDEROSA DR WORTH
Mailing Address - Street 2:SUITE D-211
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2367
Mailing Address - Country:US
Mailing Address - Phone:805-484-2818
Mailing Address - Fax:805-482-0028
Practice Address - Street 1:2486 PONDEROSA DR WORTH
Practice Address - Street 2:SUITE D-211
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2367
Practice Address - Country:US
Practice Address - Phone:805-484-2818
Practice Address - Fax:805-482-0028
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG33451208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ75674ZMedicaid