Provider Demographics
NPI:1386821791
Name:GOULD, BRETT CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:CHRISTOPHER
Last Name:GOULD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 TIMBER RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-5028
Mailing Address - Country:US
Mailing Address - Phone:205-939-9175
Mailing Address - Fax:205-558-2061
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-9175
Practice Address - Fax:205-558-2061
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1071330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily