Healthcare Provider Details

I. General information

NPI: 1063576494
Provider Name (Legal Business Name): ANZ GOULD INVESTMENTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 LURLEEN B WALLACE BLVD
NORTHPORT AL
35476-3249
US

IV. Provider business mailing address

PO BOX 1314
NORTHPORT AL
35476-6314
US

V. Phone/Fax

Practice location:
  • Phone: 205-330-9898
  • Fax: 205-330-9930
Mailing address:
  • Phone: 205-330-5251
  • Fax: 205-330-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number272
License Number StateAL

VIII. Authorized Official

Name: DR. BARRY J GOULD
Title or Position: PRESIDENT, OWNER
Credential: DPM
Phone: 205-534-1288