Healthcare Provider Details

I. General information

NPI: 1376511956
Provider Name (Legal Business Name): MICHAEL A GOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12697 E 51ST ST
TULSA OK
74146-6236
US

IV. Provider business mailing address

12697 E 51ST ST
TULSA OK
74146-6236
US

V. Phone/Fax

Practice location:
  • Phone: 918-505-3200
  • Fax: 918-505-3253
Mailing address:
  • Phone: 918-505-3200
  • Fax: 918-505-3253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number19758
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: