Provider Demographics
NPI:1205809662
Name:WILLIAM M GOULD MD INC
Entity type:Organization
Organization Name:WILLIAM M GOULD MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MORRIS
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-327-5783
Mailing Address - Street 1:750 WELCH RD
Mailing Address - Street 2:STE 218
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1509
Mailing Address - Country:US
Mailing Address - Phone:650-327-5783
Mailing Address - Fax:650-327-5510
Practice Address - Street 1:750 WELCH RD
Practice Address - Street 2:STE 218
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1509
Practice Address - Country:US
Practice Address - Phone:650-327-5783
Practice Address - Fax:650-327-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000G65624207N00000X
CA000G60590207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000G60590Medicare UPIN
CAZZZ16305ZMedicare ID - Type Unspecified