Healthcare Provider Details

I. General information

NPI: 1710070750
Provider Name (Legal Business Name): ROBERT M. GOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S YALE AVE SUITE 507
TULSA OK
74136-7823
US

IV. Provider business mailing address

6465 S YALE AVE SUITE 507
TULSA OK
74136-7823
US

V. Phone/Fax

Practice location:
  • Phone: 918-481-2760
  • Fax: 918-481-2775
Mailing address:
  • Phone: 918-481-2760
  • Fax: 918-481-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number14678
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: