Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 163985 1205 | UT |
NPI | 1043257140 |
---|---|
Provider Name | Gary K Goucher |
First Address | Ogden, UT 84403 |
Second Address | Ogden, UT 84403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 27/09/2013 |