Individual
JOHN W GOULART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
620 S MADISON ST, SUITE 108, ENID, OK 73701-7270
(580) 234-2289
(580) 249-4350
Mailing address
5300 N INDEPENDENCE AVE, 280, OKLAHOMA CITY, OK 73112-5556
(580) 234-2289
(580) 249-4350
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4191
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200032320A
—
OK
01
—
200032320B
MEDICAID OSU AJ
OK
01
—
P00155199
RR MEDICARE
OK
Enumeration date
07/26/2005
Last updated
02/09/2018
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