Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | D0032171 | MD |
N | 207QG0300X | Family Doctor - Geriatric Medicine | D0032171 | MD |
NPI | 1346223955 |
---|---|
Provider Name | Richard L Gough |
First Address | Frederick, MD 21703-8624 |
Second Address | Walkersville, MD 21793-8230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 02/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
926580505 | (05) | MD |
926580506 | (05) | MD |
D71529 | (02) | MD |