Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 034352 | GA |
Y | 207T00000X | Neurosurgeon | 036136713 | IL |
NPI | 1083704555 |
---|---|
Provider Name | Mark A. Gold |
First Address | Quincy, IL 62301-3027 |
Second Address | Quincy, IL 62301-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 29/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E85322 | (02) | GA |
P00357379 | RAILROAD (01) | GA |