MEDICARE: RANDY BRUCE GOULD DO

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	207RC0000X	Cardiovascular Disease Physician	OS7937	FL
2	207RC0000X	Cardiovascular Disease Physician	204733	NY

General Provider Information

NPI Number	:	1184630352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY BRUCE GOULD DO

Provider Business Mailing Address
First Line	:	171A E 65TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6607
Country	:	US
Telephone Number	:	212-223-1025
Fax Number	:	212-750-3201

Provider Business Practice Location Address
First Line	:	171A E 65TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6607
Country	:	US
Telephone Number	:	212-223-1025
Fax Number	:	212-750-3201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/26/2024

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Directions to “ RANDY BRUCE GOULD DO” Practice Location

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