Individual
TYLER JAMES GOUGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 S NEW BALLAS RD STE 510, SAINT LOUIS, MO 63141-8726
(314) 251-6710
(314) 251-6712
Mailing address
331 HOSPITAL DR STE A, LEBANON, MO 65536-9251
(417) 533-6560
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
2020020734
MO
Other
Enumeration date
06/09/2017
Last updated
12/08/2023
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