Healthcare Provider Details

I. General information

NPI: 1093861718
Provider Name (Legal Business Name): MR. WALTER H GOULD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COAST GUARD INTEGRATED SUPPORT COMMAND BLD1
ALAMEDA CA
94501
US

IV. Provider business mailing address

COAST ISLAND BLDG 1 MEDICAL COMMANDING OFFICER
ALAMEDA CA
94501
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-3614
  • Fax:
Mailing address:
  • Phone: 510-437-3614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: