Individual
JACQUELYN GOUVEIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
43339
CO
207RI0200X
Infectious Disease Physician
Primary
M8004
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121139100
—
WY
05
—
194705301
—
TX
05
—
194705302
—
TX
05
—
58850741
—
NM
05
—
64573320
—
CO
01
—
671851
ANTHEM BCBS
CO
01
—
7660616
AETNA
CO
Enumeration date
12/15/2006
Last updated
07/31/2023
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