Provider Demographics
NPI:1235328782
Name:GOULD FAMILY PRACTICE, P.A.
Entity Type:Organization
Organization Name:GOULD FAMILY PRACTICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-894-4800
Mailing Address - Street 1:11811 FM 1960 RD W STE 190
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3829
Mailing Address - Country:US
Mailing Address - Phone:281-894-4800
Mailing Address - Fax:281-894-7900
Practice Address - Street 1:11811 FM 1960 RD W STE 190
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3829
Practice Address - Country:US
Practice Address - Phone:281-894-4800
Practice Address - Fax:281-894-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0058HWOtherBLUE CROSS BLUE SHIELD
TX00402HMedicare PIN