Healthcare Provider Details

I. General information

NPI: 1962795963
Provider Name (Legal Business Name): BRYAN MATTHEW GOUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 S PROSPECT ST STE 2
MARION OH
43302-6283
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-7833
  • Fax: 740-387-5244
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35126841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: