Healthcare Provider Details

I. General information

NPI: 1104858422
Provider Name (Legal Business Name): JUDITH GOLD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 THIS WAY SUITE B
LAKE JACKSON TX
77074
US

IV. Provider business mailing address

7777 SOUTHWEST FREEWAY SUITE 1052
HOUSTON TX
77074
US

V. Phone/Fax

Practice location:
  • Phone: 979-297-2220
  • Fax: 979-297-3330
Mailing address:
  • Phone: 713-988-8776
  • Fax: 713-988-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberJ9058
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: