Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | ME0060292 | FL |
NPI | 1184755654 |
---|---|
Provider Name | Dr. David Gaughan |
First Address | Ormond Beach, FL 32174-3883 |
Second Address | Daytona Beach Shores, FL 32118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |