Provider Demographics
NPI:1942349949
Name:GOULD, MARK T (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 117345
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7345
Mailing Address - Country:US
Mailing Address - Phone:904-346-3465
Mailing Address - Fax:904-858-6489
Practice Address - Street 1:1577 ROBERTS DR STE 225
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3265
Practice Address - Country:US
Practice Address - Phone:904-241-1204
Practice Address - Fax:904-241-7331
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2021-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME131538207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery