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General NPI Number Information
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NPI Number | 1073867651
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Entity Type | Organization
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Legal Business Name | JOHN GOULDY, MD, PA
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Dates
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Enumeration Date | 11/03/2012
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Last Update Date | 11/03/2012
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Provider Practice Location Address
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Address Line | 3505 BOCA CHICA BLVD 110
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City | BROWNSVILLE
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State | TX
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Zip | 78521-4214
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Country | US
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Telephone | 956-234-3825
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Fax |
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Provider Business Mailing Address
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Address Line | 3505 BOCA CHICA BLVD 110
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City | BROWNSVILLE
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State | TX
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Zip | 78521-4214
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Country | US
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Telephone | 956-234-3825
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN PRICE GOULDY
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Credential | M.D.
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Telephone | 956-234-3825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | N0058
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License Number State | TX
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