Healthcare Provider Details

I. General information

NPI: 1700310844
Provider Name (Legal Business Name): MAKS GOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E STAR CT
MONTROSE CO
81401-6701
US

IV. Provider business mailing address

601 E STAR CT
MONTROSE CO
81401-6701
US

V. Phone/Fax

Practice location:
  • Phone: 970-615-2880
  • Fax: 833-764-3551
Mailing address:
  • Phone: 970-615-2880
  • Fax: 833-764-3551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0073238
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: