Provider Demographics
NPI:1073867651
Name:JOHN GOULDY, MD, PA
Entity Type:Organization
Organization Name:JOHN GOULDY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PRICE
Authorized Official - Last Name:GOULDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-234-3825
Mailing Address - Street 1:3505 BOCA CHICA BLVD
Mailing Address - Street 2:110
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4214
Mailing Address - Country:US
Mailing Address - Phone:956-234-3825
Mailing Address - Fax:
Practice Address - Street 1:3505 BOCA CHICA BLVD
Practice Address - Street 2:110
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4214
Practice Address - Country:US
Practice Address - Phone:956-234-3825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN00582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty