Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | A80679 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | OMS41 | CA |
NPI | 1699738930 |
---|---|
Provider Name | Evan S Gold |
First Address | Escondido, CA 92025-3363 |
Second Address | Escondido, CA 92025-3363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 08/07/2007 |