Provider Demographics
NPI:1437223211
Name:GOULD, ROBERT SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAMUEL
Last Name:GOULD
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 1:320 DARDANELLI LANE
Mailing Address - Street 2:SUITE 23B
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-866-4866
Mailing Address - Fax:408-866-8849
Practice Address - Street 1:320 DARDANELLI LANE
Practice Address - Street 2:SUITE 23B
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-866-4866
Practice Address - Fax:408-866-8849
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG476962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G476960Medicare ID - Type Unspecified
CAA89862Medicare UPIN