Provider Information for 1104837541
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Dr. BRUCE E. GOULD M.D.
Sex: Male
NPI: 1104837541
Last Updated: 2010-07-29
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1104837541 | ||||||||
| Enumeration Date | 2006-08-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 131 COVENTRY ST BURGDORF CLINIC - 2ND FLOOR HARTFORD, CT 06112-1548 United States Phone: 860-714-3690 | Fax:860-714-8683 | ||||||||
| Primary Practice Address | 131 COVENTRY ST BURGDORF CLINIC - 2ND FLOOR HARTFORD, CT 06112-1548 United States Phone: 860-714-3690 | Fax:860-714-8683 | ||||||||
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