Provider Demographics
NPI:1184755654
Name:GAUGHAN, DAVID (M,D)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GAUGHAN
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3883
Mailing Address - Country:US
Mailing Address - Phone:386-767-9544
Mailing Address - Fax:386-756-0501
Practice Address - Street 1:3512 S ATLANTIC AV.
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH SHORES
Practice Address - State:FL
Practice Address - Zip Code:32118
Practice Address - Country:US
Practice Address - Phone:386-767-9544
Practice Address - Fax:386-756-0501
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00602922081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12582Medicare ID - Type Unspecified