Provider Demographics
NPI:1972501724
Name:GOULD, ROBERT E (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:GOULD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:7550 LUCERNE DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MIDDLEBURG HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6503
Mailing Address - Country:US
Mailing Address - Phone:440-234-8833
Mailing Address - Fax:440-234-3313
Practice Address - Street 1:450 ALKYRE RUN STE 360
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6914
Practice Address - Country:US
Practice Address - Phone:614-918-9808
Practice Address - Fax:614-918-9807
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2019-08-20
Deactivation Date:
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Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009895208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2352430Medicaid
IN200405070Medicaid
OHH292801Medicare PIN
OHH199720Medicare PIN
OH2352430Medicaid
IN200405070Medicaid