Provider Demographics
NPI:1740289883
Name:GOULD, DEBRA A (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:GOULD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2715
Mailing Address - Country:US
Mailing Address - Phone:509-248-7849
Mailing Address - Fax:509-248-8291
Practice Address - Street 1:504 N 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4311
Practice Address - Country:US
Practice Address - Phone:509-966-9480
Practice Address - Fax:509-225-2702
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8140154Medicaid
WA8939873OtherCRIME VICTIM
WA0107394OtherLABOR & INDUSTRIES
WAP00059088OtherRAILROAD MEDICARE
WA8939873OtherCRIME VICTIM
WAAB38067Medicare PIN