MEDICARE: DR. JAN JACK GOUDA M.D.

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	207T00000X	Neurological Surgery Physician	35-072594	OH
2	208VP0000X	Pain Medicine Physician	35-072594	OH

General Provider Information

NPI Number	:	1427163906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAN JACK GOUDA M.D.

Provider Business Mailing Address
First Line	:	1 ELIZABETH PL
Second Line	:	SUITE # D
City	:	DAYTON
State	:	OH
Zip	:	45417-3445
Country	:	US
Telephone Number	:	937-424-2520
Fax Number	:	937-222-9665

Provider Business Practice Location Address
First Line	:	1 ELIZABETH PL
Second Line	:	SUITE # D
City	:	DAYTON
State	:	OH
Zip	:	45417-3445
Country	:	US
Telephone Number	:	937-424-2520
Fax Number	:	937-222-9665

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	02/20/2026

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