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NPI Code Detail

MEDICARE: ANDREA GOUGH-GOLDMAN MD

MEDICARE: ANDREA GOUGH-GOLDMAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207QA0401XAddiction Medicine (Family Medicine) PhysicianMD172073OR

General Provider Information

NPI Number : 1013273861
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA GOUGH-GOLDMAN MD
Provider Business Mailing Address
First Line : 3580 SE 82ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97266-2902
Country : US
Telephone Number : 719-339-9240
Fax Number :
Provider Business Practice Location Address
First Line : 3580 SE 82ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97266-2902
Country : US
Telephone Number : 971-339-9240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2012
Last Update Date : 02/14/2023

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