Provider Demographics
NPI:1578713947
Name:JOSEPH MACK GOULD
Entity Type:Organization
Organization Name:JOSEPH MACK GOULD
Other - Org Name:JOSEPH MACK GOULD MS DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-757-0037
Mailing Address - Street 1:PO BOX 1909
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831-1909
Mailing Address - Country:US
Mailing Address - Phone:432-837-0084
Mailing Address - Fax:432-837-0093
Practice Address - Street 1:178 OAK HILL DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76087-7453
Practice Address - Country:US
Practice Address - Phone:817-757-0037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1561213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5074820001Medicare NSC