Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G47614 | CA |
Y | 207R00000X | Internist | G47614 | CA |
Y | 111NI0900X | Internist | G47614 | CA |
N | 207RG0300X | Geriatric Medicine | G47614 | CA |
NPI | 1164489456 |
---|---|
Provider Name | Robert A Gold |
First Address | Thousand Oaks, CA 91362-5802 |
Second Address | Thousand Oaks, CA 91362-5802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 08/10/2012 |