Healthcare Provider Details

I. General information

NPI: 1467436857
Provider Name (Legal Business Name): WAYNE C GOULD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 CENTRAL AVE STE J DOVER FOOT SPECIALTY CTR, PC
DOVER NH
03820-3434
US

IV. Provider business mailing address

750 CENTRAL AVE SUITE J
DOVER NH
03820-3434
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-2245
  • Fax: 603-742-0712
Mailing address:
  • Phone: 603-742-2245
  • Fax: 603-742-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD1015
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0187
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: