Healthcare Provider Details

I. General information

NPI: 1972501724
Provider Name (Legal Business Name): ROBERT E GOULD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ALKYRE RUN STE 360
WESTERVILLE OH
43082-6914
US

IV. Provider business mailing address

19645 PROGRESS DR
STRONGSVILLE OH
44149-3205
US

V. Phone/Fax

Practice location:
  • Phone: 614-918-9808
  • Fax: 614-918-9807
Mailing address:
  • Phone: 440-234-8833
  • Fax: 440-234-3313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number34009895
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: