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General NPI Number Information
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NPI Number | 1831244912
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Entity Type | Organization
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Legal Business Name | WATERFORD MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 05/14/2010
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Provider Practice Location Address
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Address Line | 3560 PONTIAC LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-2337
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Country | US
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Telephone | 248-674-2259
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Fax | 248-674-3356
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Provider Business Mailing Address
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Address Line | 3560 PONTIAC LAKE RD
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City | WATERFORD
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State | MI
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Zip | 48328-2337
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Country | US
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Telephone | 248-674-2259
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Fax | 248-674-3356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL MARTIN GOLD
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Credential | DO
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Telephone | 248-674-2259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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