Provider Demographics
NPI:1942349949
Name:GOULD, MARK T (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:GOULD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:132 INDIAN HAMMOCK LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2155
Mailing Address - Country:US
Mailing Address - Phone:619-865-4915
Mailing Address - Fax:
Practice Address - Street 1:1536 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6525
Practice Address - Country:US
Practice Address - Phone:904-475-6319
Practice Address - Fax:904-475-5809
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME131538207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery