Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 00632 | SC |
Y | 111NI0900X | Internist | 00632 | SC |
N | 207RH0002X | Hospice and Palliative Medicine | 632 | SC |
NPI | 1215922091 |
---|---|
Provider Name | Dr. John Gould III |
First Address | Irmo, SC 29063-2903 |
Second Address | Irmo, SC 29063-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 07/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006326 | (05) | SC |