Individual
DR. STEVEN JAY GOULDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
036-108689
IL
207NS0135X
Procedural Dermatology Physician
036-108689
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36108689
—
IL
01
—
K09943
MEDICARE
IL
Enumeration date
12/29/2005
Last updated
09/12/2012
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