Healthcare Provider Details

I. General information

NPI: 1447598412
Provider Name (Legal Business Name): GOLD PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2013
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3604 S COOPER ST 120
ARLINGTON TX
76015-3481
US

IV. Provider business mailing address

PO BOX 204181
DALLAS TX
75320-4181
US

V. Phone/Fax

Practice location:
  • Phone: 817-466-8008
  • Fax: 817-466-8131
Mailing address:
  • Phone: 817-466-8008
  • Fax: 817-466-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GOLD
Title or Position: PRESIDENT
Credential: MD
Phone: 817-466-8008