Provider Demographics
NPI:1043302821
Name:GOUIN, MARIE CARMEL MAY (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CARMEL MAY
Last Name:GOUIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAY
Other - Middle Name:
Other - Last Name:GOUIN-DUMOULIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5682 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1540
Mailing Address - Country:US
Mailing Address - Phone:941-371-3349
Mailing Address - Fax:
Practice Address - Street 1:5682 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1540
Practice Address - Country:US
Practice Address - Phone:941-371-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95317261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ074236OtherPIN
NJH98512Medicare UPIN