Provider Demographics
NPI:1912992140
Name:GOULD, RICHARD SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SAMUEL
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8360 SIERRA MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7328
Mailing Address - Country:US
Mailing Address - Phone:239-624-8300
Mailing Address - Fax:239-403-7802
Practice Address - Street 1:8360 SIERRA MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7328
Practice Address - Country:US
Practice Address - Phone:239-624-8300
Practice Address - Fax:239-403-7802
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336072558207Q00000X
KST-01043207Q00000X
FLME101172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000461500Medicaid
I44959Medicare UPIN
FLAX656Medicare PIN