MEDICARE: JOHN J 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	207RC0000X	Cardiovascular Disease Physician	200000805	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	127MW	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568424612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J GOULD MD

Provider Business Mailing Address
First Line	:	PO BOX 896206
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28289-6206
Country	:	US
Telephone Number	:	252-808-0145
Fax Number	:	252-808-2770

Provider Business Practice Location Address
First Line	:	4252 ARENDELL ST
Second Line	:	SUITE E
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-2866
Country	:	US
Telephone Number	:	252-808-0145
Fax Number	:	252-808-2770

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

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	03/17/2017

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