Provider Demographics
NPI:1366419103
Name:GOULD, RICHARD RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:RAYMOND
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 1:34509 9TH AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8708
Mailing Address - Country:US
Mailing Address - Phone:253-927-1800
Mailing Address - Fax:253-952-3025
Practice Address - Street 1:34509 9TH AVE S STE 204
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8708
Practice Address - Country:US
Practice Address - Phone:253-927-1800
Practice Address - Fax:253-952-3025
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7155208600000X
WAMD00049150208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0265481OtherSTATE L&I
MT0103012Medicaid
WA0229088OtherSTATE L&I
WA0228752OtherSTATE L&I
WA0228753OtherSTATE L&I
WA0265481OtherSTATE L&I
WA0229088OtherSTATE L&I
F08516Medicare UPIN
WAG8870506Medicare PIN