Provider Demographics
NPI:1477641173
Name:GOULD, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
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 1:1200 KEITH AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94708-1600
Mailing Address - Country:US
Mailing Address - Phone:510-841-0499
Mailing Address - Fax:
Practice Address - Street 1:750 WELCH RD
Practice Address - Street 2:SUITE 315
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1507
Practice Address - Country:US
Practice Address - Phone:650-723-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG193982080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A40628Medicare UPIN