Provider Demographics
NPI:1447223565
Name:GOLD, MITCHELL J (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:GOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20713 E OCOTILLO RD STE 100
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6117
Mailing Address - Country:US
Mailing Address - Phone:480-882-9993
Mailing Address - Fax:480-248-2377
Practice Address - Street 1:20713 E OCOTILLO RD STE 100
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6117
Practice Address - Country:US
Practice Address - Phone:480-882-9993
Practice Address - Fax:480-248-2377
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ961468Medicaid
AZ105347Medicare ID - Type Unspecified
AZ961468Medicaid