=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669438602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARRY J GOULD DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2006
-----------------------------------------------------
Last Update Date | 07/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1788 MCFARLAND BLVD N SUITE B
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35406-2190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-759-9100
-----------------------------------------------------
Fax | 205-759-1821
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1788 MCFARLAND BLVD N SUITE B
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35406-2190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-759-9100
-----------------------------------------------------
Fax | 205-759-1821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number | 272
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | 272
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 272
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 213EP0504X
-----------------------------------------------------
Taxonomy Name | Public Medicine Podiatrist
-----------------------------------------------------
License Number | 272
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 213ER0200X
-----------------------------------------------------
Taxonomy Name | Radiology Podiatrist
-----------------------------------------------------
License Number | 272
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 213ES0000X
-----------------------------------------------------
Taxonomy Name | Sports Medicine Podiatrist
-----------------------------------------------------
License Number | 272
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 272
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 272
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------