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NPI Code Detail

MEDICARE: PROF. TRENTON EDWARD GOULD PHD, ATC

MEDICARE: PROF. TRENTON EDWARD GOULD PHD, ATC
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
12255A2300XAthletic TrainerAT0323MS

General Provider Information

NPI Number : 1972683662
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. TRENTON EDWARD GOULD PHD, ATC
Provider Business Mailing Address
First Line : 97 CRYSTAL CRK
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-8497
Country : US
Telephone Number : 601-266-6339
Fax Number :
Provider Business Practice Location Address
First Line : 118 COLLEGE DR
Second Line : BOX 5040
City : HATTIESBURG
State : MS
Zip : 39406-0001
Country : US
Telephone Number : 601-266-6339
Fax Number : 601-266-4445
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 11/14/2014

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