Healthcare Provider Details

I. General information

NPI: 1851355804
Provider Name (Legal Business Name): ADAM C GOUGH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E 32ND ST
SILVER CITY NM
88061-7287
US

IV. Provider business mailing address

1600 E 32ND ST
SILVER CITY NM
88061-7287
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-2981
  • Fax: 575-388-3373
Mailing address:
  • Phone: 575-538-2981
  • Fax: 575-388-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number275
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: