Healthcare Provider Details

I. General information

NPI: 1811145261
Provider Name (Legal Business Name): JOHN FREDERICK GOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY BOX U109
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

PO BOX 1123 255 WEST MICHIGAN AVENUE
JACKSON MI
49204-1123
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9220
  • Fax: 865-637-5518
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number66038
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: