Healthcare Provider Details

I. General information

NPI: 1538278379
Provider Name (Legal Business Name): WILLIAM STUART GOULD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13118 121ST WAY NE SUITE 100
KIRKLAND WA
98034-3004
US

IV. Provider business mailing address

PO BOX 1165
GOLD BAR WA
98251-1165
US

V. Phone/Fax

Practice location:
  • Phone: 360-793-9776
  • Fax: 360-793-7697
Mailing address:
  • Phone: 360-793-9776
  • Fax: 360-793-7697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0019957
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: