MEDICARE: GOLD PHYSICAL MEDICINE AND REHABILITATION PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1861986465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD PHYSICAL MEDICINE AND REHABILITATION PC

Provider Business Mailing Address
First Line	:	840 S RANCHO DR STE 4-740
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3837
Country	:	US
Telephone Number	:	702-242-6911
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 S RANCHO DR STE 4-740
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3837
Country	:	US
Telephone Number	:	702-242-6911
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STANLEY POOLE
Credential	:	DO
Telephone Number	:	801-556-5859

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	05/03/2024

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