MEDICARE: DR. JENNIFER W GOULD 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	207N00000X	Dermatology Physician	35069468	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	070012084	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000140612	OTHER	OH	ANTHEM BLUE CROSS

General Provider Information

NPI Number	:	1851398507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER W GOULD M.D.

Provider Business Mailing Address
First Line	:	2500 W STRUB RD
Second Line	:	SUITE 330
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5390
Country	:	US
Telephone Number	:	419-626-6700
Fax Number	:	419-626-6710

Provider Business Practice Location Address
First Line	:	2500 W STRUB RD
Second Line	:	SUITE 330
City	:	SANDUSKY
State	:	OH
Zip	:	44870-5390
Country	:	US
Telephone Number	:	419-626-6700
Fax Number	:	419-626-6710

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	06/26/2012

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