Provider Demographics
NPI:1316960628
Name:GOLD, JASON (DPM)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GOLD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 GLADES RD
Mailing Address - Street 2:STE. 320
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6461
Mailing Address - Country:US
Mailing Address - Phone:561-750-3033
Mailing Address - Fax:561-750-3443
Practice Address - Street 1:670 GLADES RD
Practice Address - Street 2:STE. 320
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6461
Practice Address - Country:US
Practice Address - Phone:561-750-3033
Practice Address - Fax:561-750-3443
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3130213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340481100Medicaid
FL340481100Medicaid
FL65858AMedicare ID - Type Unspecified