Provider Demographics
NPI:1235143447
Name:GOULD, BARBARA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LYNN
Last Name:GOULD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 APEL AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-1680
Mailing Address - Country:US
Mailing Address - Phone:507-372-4608
Mailing Address - Fax:
Practice Address - Street 1:1023 APEL AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1680
Practice Address - Country:US
Practice Address - Phone:507-372-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34003207R00000X, 208000000X
WI44665207R00000X, 208000000X
AK5253207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics