Organization
GOUGH SURGICAL PLLC
Active
Organization
GOUGH SURGICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON E GOUGH MD (PRESIDENT)
(316) 617-0428
Entity
Organization
Contact information
Practice address
9571 E NITTANY DR, SCOTTSDALE, AZ 85255-5555
(316) 617-0428
Mailing address
PO BOX 39179, PHOENIX, AZ 85069-9179
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053537779
NATIONAL PROVIDER IDENTIFIER
—
Enumeration date
01/06/2020
Last updated
01/06/2020
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