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General NPI Number Information
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NPI Number | 1821340753
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Entity Type | Organization
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Legal Business Name | L.A. GOLD, M.D., P.C.
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 3225 INTERNATIONAL CIR STE 210
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3161
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Country | US
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Telephone | 719-635-5223
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Fax | 719-635-6035
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Provider Business Mailing Address
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Address Line | 3225 INTERNATIONAL CIR STE 210
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3161
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Country | US
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Telephone | 719-635-5223
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Fax | 719-635-6035
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LARRY ALAN GOLD
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Credential | M.D.
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Telephone | 719-635-5223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 22116
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License Number State | CO
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