Provider Demographics
NPI:1477504165
Name:GOULD, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
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:PO BOX 8449
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8449
Mailing Address - Country:US
Mailing Address - Phone:270-444-3930
Mailing Address - Fax:270-442-5284
Practice Address - Street 1:2603 KENTUCKY AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3814
Practice Address - Country:US
Practice Address - Phone:270-444-3930
Practice Address - Fax:270-442-5284
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25389207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64253891Medicaid
KY000000050178OtherANTHEM
KY830000495OtherRAILROAD MEDICARE
KY000000050178OtherANTHEM
KY0548501Medicare ID - Type UnspecifiedKY MCARE
IL$$$$$$$$$Medicaid
IL998760Medicare ID - Type UnspecifiedIL MCARE