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NPI Code Detail

MEDICARE: WILFRED EDWIN GOULD III MD

MEDICARE: WILFRED EDWIN GOULD III 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
1207Q00000XFamily Medicine Physician27452MN
2208M00000XHospitalist Physician27452MN

General Provider Information

NPI Number : 1720025265
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILFRED EDWIN GOULD III MD
Provider Business Mailing Address
First Line : 290 MAIN ST NW
Second Line :
City : ELK RIVER
State : MN
Zip : 55330-1270
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 290 MAIN ST NW
Second Line :
City : ELK RIVER
State : MN
Zip : 55330-1270
Country : US
Telephone Number : 763-241-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 05/09/2025

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