Provider Demographics
NPI:1396885281
Name:MCGOUGH, JANELLE L (DO)
Entity type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:L
Last Name:MCGOUGH
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 1:6531 PINE CREST CIR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-1938
Mailing Address - Country:US
Mailing Address - Phone:916-962-2355
Mailing Address - Fax:
Practice Address - Street 1:6531 PINE CREST CIR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-1938
Practice Address - Country:US
Practice Address - Phone:916-962-2355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8562207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX85620Medicaid
I18059Medicare UPIN
CA00AX85620Medicaid