Healthcare Provider Details

I. General information

NPI: 1053948406
Provider Name (Legal Business Name): THOMAS GAUGHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

4901 FOREST PARK AVE
SAINT LOUIS MO
63108-1495
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-5470
  • Fax: 314-362-3335
Mailing address:
  • Phone: 314-747-5470
  • Fax: 314-362-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2026030730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: