MEDICARE: DR. MARK E. GOLD MD FACS

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	208200000X	Plastic Surgery Physician	G56311	CA

General Provider Information

NPI Number	:	1912182155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK E. GOLD MD FACS

Provider Business Mailing Address
First Line	:	16486 BERNARDO CENTER DR
Second Line	:	SUITE C 150
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2518
Country	:	US
Telephone Number	:	858-451-3060
Fax Number	:

Provider Business Practice Location Address
First Line	:	16486 BERNARDO CENTER DR
Second Line	:	SUITE C 150
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2518
Country	:	US
Telephone Number	:	858-451-3060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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