Provider Demographics
NPI:1811042708
Name:GOULD, RONALD JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOHN
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1035 BELLEVUE AVE
Mailing Address - Street 2:204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1854
Mailing Address - Country:US
Mailing Address - Phone:314-645-1344
Mailing Address - Fax:314-645-6457
Practice Address - Street 1:1035 BELLEVUE AVE
Practice Address - Street 2:204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1854
Practice Address - Country:US
Practice Address - Phone:314-645-1344
Practice Address - Fax:314-645-6457
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2011-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR9020207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA13144Medicare UPIN