Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 33338 | AL |
NPI | 1063656858 |
---|---|
Provider Name | Stephen Gould |
First Address | Birmingham, AL 35205-3422 |
Second Address | Birmingham, AL 35205-3422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2009 |
Last Update Date | 12/11/2015 |