Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | R4C51 | MO |
N | 111NI0900X | Internist | R4C51 | MO |
Y | 207R00000X | Internist | R4N51 | MO |
Y | 111NI0900X | Internist | R4N51 | MO |
N | 207RA0201X | Internist - Allergy & Immunology | R4N51 | MO |
NPI | 1093732026 |
---|---|
Provider Name | Andrew S Gold |
First Address | Saint Louis, MO 63131-2324 |
Second Address | Saint Louis, MO 63131-2324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 11/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207883216 | (05) | MO |
F78339 | (02) |