MEDICARE: JOHN GOULDY, MD, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	N0058	TX

General Provider Information

NPI Number	:	1073867651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN GOULDY, MD, PA

Provider Business Mailing Address
First Line	:	3505 BOCA CHICA BLVD
Second Line	:	110
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-4214
Country	:	US
Telephone Number	:	956-234-3825
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 BOCA CHICA BLVD
Second Line	:	110
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-4214
Country	:	US
Telephone Number	:	956-234-3825
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN PRICE GOULDY
Credential	:	M.D.
Telephone Number	:	956-234-3825

Provider Enumeration Date	:	11/03/2012
Last Update Date	:	11/03/2012

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