Healthcare Provider Details

I. General information

NPI: 1639166820
Provider Name (Legal Business Name): ROBERT G GOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 ENTERPRISE CENTER BLVD SUITE201
BOYNTON BEACH FL
33437-3759
US

IV. Provider business mailing address

10151 ENTERPRISE CENTER BLVD SUITE201
BOYNTON BEACH FL
33437-3759
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-9191
  • Fax: 561-733-9145
Mailing address:
  • Phone: 561-737-9191
  • Fax: 561-733-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number074581
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0050340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: