Provider Demographics
NPI:1033220991
Name:GOLDEN, PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 NELSON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5341
Mailing Address - Country:US
Mailing Address - Phone:209-576-1547
Mailing Address - Fax:209-576-2736
Practice Address - Street 1:1330 NELSON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5341
Practice Address - Country:US
Practice Address - Phone:209-576-1547
Practice Address - Fax:209-576-2736
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30602207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G306021Medicaid
CA00G306020Medicare ID - Type Unspecified
CA00G306021Medicaid