Healthcare Provider Details

I. General information

NPI: 1932213071
Provider Name (Legal Business Name): WILLIAM DAVID GOULD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 3RD ST DAYTON VAMC, PCL (LLC)
DAYTON OH
45428-9000
US

IV. Provider business mailing address

3204 BOB WHITE PL
BEAVERCREEK OH
45431-3364
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-262-5998
Mailing address:
  • Phone: 937-268-6511
  • Fax: 937-262-5998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number66034
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number66034
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: