Healthcare Provider Details

I. General information

NPI: 1861986465
Provider Name (Legal Business Name): GOLD PHYSICAL MEDICINE AND REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S RANCHO DR STE 4-740
LAS VEGAS NV
89106-3837
US

IV. Provider business mailing address

840 S RANCHO DR STE 4-740
LAS VEGAS NV
89106-3837
US

V. Phone/Fax

Practice location:
  • Phone: 702-242-6911
  • Fax:
Mailing address:
  • Phone: 702-242-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: STANLEY SCOTTORN POOLE
Title or Position: MANAGER
Credential: DO
Phone: 801-556-5859