Provider Demographics
NPI:1215229646
Name:GOUGH, ANGELA RENEE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:RENEE
Last Name:GOUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 ALA MOANA BLVD
Mailing Address - Street 2:STE 226
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5499
Mailing Address - Country:US
Mailing Address - Phone:808-521-2437
Mailing Address - Fax:
Practice Address - Street 1:677 ALA MOANA BLVD STE 226
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5416
Practice Address - Country:US
Practice Address - Phone:808-521-2437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-16742084P0802X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry