Provider Demographics
NPI:1467436857
Name:GOULD, WAYNE C (DPM)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:C
Last Name:GOULD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:750 CENTRAL AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3434
Mailing Address - Country:US
Mailing Address - Phone:603-742-2245
Mailing Address - Fax:603-742-0712
Practice Address - Street 1:750 CENTRAL AVE STE J
Practice Address - Street 2:DOVER FOOT SPECIALTY CTR, PC
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3434
Practice Address - Country:US
Practice Address - Phone:603-742-2245
Practice Address - Fax:603-742-0712
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1015213ES0103X
NH0187213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80008271Medicaid
NH80008271Medicaid
NHT25740Medicare UPIN
NH4534100001Medicare NSC