Healthcare Provider Details

I. General information

NPI: 1093072837
Provider Name (Legal Business Name): STEPHANIE GOLD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 YOSEMITE ST LOWRY FAMILY HEALTH CENTER
DENVER CO
80230
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-4545
  • Fax: 303-602-4550
Mailing address:
  • Phone: 303-436-4949
  • Fax: 303-602-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0054902
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: