Healthcare Provider Details

I. General information

NPI: 1821350455
Provider Name (Legal Business Name): AARON P GOULD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 MONTVALE DR STE A
SPRINGFIELD IL
62704-6924
US

IV. Provider business mailing address

3050 MONTVALE DR STE A
SPRINGFIELD IL
62704-6924
US

V. Phone/Fax

Practice location:
  • Phone: 217-726-8096
  • Fax:
Mailing address:
  • Phone: 217-726-8096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number78945
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036146138
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2017011826
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: