MEDICARE: DR. JAMES DEAN GOULD M.D.

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	174400000X	Specialist	103466	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G95138	OTHER		UPIN

General Provider Information

NPI Number	:	1912908161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DEAN GOULD M.D.

Provider Business Mailing Address
First Line	:	1390 HIGHWAY 61
Second Line	:	SUITE 3100
City	:	FESTUS
State	:	MO
Zip	:	63028-4137
Country	:	US
Telephone Number	:	636-931-7380
Fax Number	:	636-937-5546

Provider Business Practice Location Address
First Line	:	1390 HIGHWAY 61
Second Line	:	SUITE 3100
City	:	FESTUS
State	:	MO
Zip	:	63028-4137
Country	:	US
Telephone Number	:	636-931-7380
Fax Number	:	636-937-5546

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	10/02/2007

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