Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 9142 | SD |
NPI | 1003127903 |
---|---|
Provider Name | Dr. Andrew Robert Gough |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Aberdeen, SD 57401-5420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 03/10/2019 |