Provider Demographics
NPI:1063656858
Name:GOULD, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 AL HIGHWAY 157 STE 101
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0609
Mailing Address - Country:US
Mailing Address - Phone:256-735-5505
Mailing Address - Fax:256-964-9954
Practice Address - Street 1:1930 AL HIGHWAY 157 STE 101
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0609
Practice Address - Country:US
Practice Address - Phone:256-735-5505
Practice Address - Fax:256-964-9954
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33338207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL255877Medicaid
AL268277Medicaid