Healthcare Provider Details

I. General information

NPI: 1164616314
Provider Name (Legal Business Name): JASON LAUREN GOULD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CYPRESS CREEK RD STE 304
FORT LAUDERDALE FL
33334-3522
US

IV. Provider business mailing address

800 E CYPRESS CREEK RD STE 304
FORT LAUDERDALE FL
33334-3522
US

V. Phone/Fax

Practice location:
  • Phone: 954-289-8155
  • Fax: 954-938-5339
Mailing address:
  • Phone: 954-289-8155
  • Fax: 954-938-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberME144817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: