Provider Demographics
NPI:1689677288
Name:GOULD, JOSEPH MACK (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MACK
Last Name:GOULD
Suffix:
Gender:M
Credentials:DPM
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 1056
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-1056
Mailing Address - Country:US
Mailing Address - Phone:817-757-0037
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1561213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151298001Medicaid
TX480033979Medicare PIN
TX151298001Medicaid
TX00505PMedicare PIN