Provider Demographics
NPI:1306821822
Name:GOULD, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1130 CONROY LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4156
Mailing Address - Country:US
Mailing Address - Phone:916-773-5529
Mailing Address - Fax:916-773-0430
Practice Address - Street 1:1130 CONROY LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4156
Practice Address - Country:US
Practice Address - Phone:916-773-5529
Practice Address - Fax:916-773-0430
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG55692208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G556920Medicaid
CAE43250Medicare UPIN
CA00G556920Medicare ID - Type Unspecified