Provider Demographics
NPI:1083894117
Name:GOULDY, JOHN PRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PRICE
Last Name:GOULDY
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 1:3505 BOCA CHICA BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4064
Mailing Address - Country:US
Mailing Address - Phone:956-544-3191
Mailing Address - Fax:956-544-3197
Practice Address - Street 1:2302 BROWN ROAD
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-0731
Practice Address - Country:US
Practice Address - Phone:760-337-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA799592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry