Healthcare Provider Details

I. General information

NPI: 1205323482
Provider Name (Legal Business Name): HEATH PATRICK GOULD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3035 DEMERS AVE
GRAND FORKS ND
58201-4040
US

IV. Provider business mailing address

3035 DEMERS AVE
GRAND FORKS ND
58201-4040
US

V. Phone/Fax

Practice location:
  • Phone: 701-746-7521
  • Fax:
Mailing address:
  • Phone: 701-746-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number21340
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number21340
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: