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1275539801

NPI Code Detail

MEDICARE: ANDREW RICHARD GOULD MD

MEDICARE: ANDREW RICHARD GOULD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	32102	KY
2	207Y00000X	Otolaryngology Physician	01054760A	IN
3	207Y00000X	Otolaryngology Physician	32102	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080161658	OTHER		MEDICARE RAIL ROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275539801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW RICHARD GOULD MD

Provider Business Mailing Address
First Line	:	PO BOX 950116
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0116
Country	:	US
Telephone Number	:	502-893-0159
Fax Number	:	502-213-3853

Provider Business Practice Location Address
First Line	:	2944 BRECKENRIDGE LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1409
Country	:	US
Telephone Number	:	502-893-0159
Fax Number	:	502-213-3853

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	03/13/2020

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Directions to “ ANDREW RICHARD GOULD MD” Practice Location

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