Provider Demographics
NPI:1427163906
Name:GOUDA, JAN JACK (MD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:JACK
Last Name:GOUDA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 ELIZABETH PL
Mailing Address - Street 2:SUITE # D
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3445
Mailing Address - Country:US
Mailing Address - Phone:937-424-2520
Mailing Address - Fax:937-222-9665
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:SUITE # D
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-424-2520
Practice Address - Fax:937-222-9665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-072594207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery