Individual
DR. AIMEE E GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
419 S WASHINGTON ST STE 200, CASPER, WY 82601
(307) 577-4220
(307) 235-0931
Mailing address
419 S WASHINGTON ST STE 200, CASPER, WY 82601-2951
(307) 577-4220
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
11604A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11604A
WYOMING MEDICAL LICENSE
WY
01
—
CS01885
CONTROLLED SUBSTANCE LICENSE
WY
Enumeration date
07/09/2012
Last updated
01/07/2020
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