Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | 3111 | OK |
N | 213ER0200X | Radiology | 3111 | OK |
Y | 111NR0200X | Radiology | 3953 | KS |
Y | 213ER0200X | Radiology | 3953 | KS |
NPI | 1386645349 |
---|---|
Provider Name | Dr. Steven Jay Gould |
First Address | Cheney, KS 67025-0190 |
Second Address | Cheney, KS 67025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 24/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060952 | BLUE CROSS BLUE SHIELD (01) | KS |
U37365 | (02) | KS |