Fredric Gough, MD

Primary specialty

Hospice and Palliative Medicine (Emergency Medicine) PhysicianTaxonomy code 207PH0002X

License

G40525 Issued in CA

Practice address

1200 B Gale Wilson Blvd
Fairfield, CA 94533-3552

Phone

(707) 429-7930

NPI assigned

Apr 11, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689897019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "646 BROWN CT",
            "city": "BENICIA",
            "state": "CA",
            "postal_code": "945103940",
            "telephone_number": "707-746-7663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 B GALE WILSON BLVD",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333552",
            "telephone_number": "707-429-7930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUGH",
        "first_name": "FREDRIC",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PH0002X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Hospice and Palliative Medicine",
            "state": "CA",
            "license": "G40525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lora Lynne Gordon, CADC II
• Jerry Andrew Gorman, MSW
• Haley Dawn Gosvener
• Steven T. Gotanda, MD
• Sharon G Goudeau-Goodall
• Heather Robyn Gough, MSW, JD
• Richard B Gould, M.D.
• Gracious Touch Home Health Care
• Alisha Graham
• Justin V Graham, MD

• Emergency Medicine Physician in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.