Healthcare Provider Details

I. General information

NPI: 1245786342
Provider Name (Legal Business Name): HERBERT JAY GOULD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 N PARK LOOP
MEMPHIS TN
38152-4220
US

IV. Provider business mailing address

4055 N PARK LOOP
MEMPHIS TN
38152-4220
US

V. Phone/Fax

Practice location:
  • Phone: 901-678-5800
  • Fax: 901-678-5497
Mailing address:
  • Phone: 901-678-5800
  • Fax: 901-678-5497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0000001034
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: