Individual
NICHOLAS GOULD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-1000
Mailing address
3640 NEW VISION DR STE A, FORT WAYNE, IN 46845-1717
(260) 482-4440
(260) 482-4442
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02004955A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001080016
ANTHEM
IN
01
—
047840077
MEDICARE
IN
05
—
201397300
—
IN
Enumeration date
06/12/2014
Last updated
03/17/2018
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