Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 0101018602 | VA |
NPI | 1023083151 |
---|---|
Provider Name | Dr. William W Gough |
First Address | Norfolk, VA 23502 |
Second Address | Norfolk, VA 23502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B60108 | (02) |