Provider Demographics
NPI:1649200296
Name:GOULD, JIM J (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:J
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2356 N 400 E
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3409
Mailing Address - Country:US
Mailing Address - Phone:435-843-8380
Mailing Address - Fax:435-843-8382
Practice Address - Street 1:2356 N 400 E
Practice Address - Street 2:SUITE 202
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3409
Practice Address - Country:US
Practice Address - Phone:435-843-8380
Practice Address - Fax:435-843-8382
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT4947065-1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTH02108Medicare UPIN