Provider Demographics
NPI:1699936237
Name:GOLD, JAY A (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
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 1:2909 LANDMARK PL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4235
Mailing Address - Country:US
Mailing Address - Phone:608-274-1940
Mailing Address - Fax:608-274-5008
Practice Address - Street 1:2909 LANDMARK PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-4235
Practice Address - Country:US
Practice Address - Phone:608-274-1940
Practice Address - Fax:608-274-5008
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI285242083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine