Provider Demographics
NPI:1053757104
Name:GOUGLER, PAMELA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JEAN
Last Name:GOUGLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4022
Mailing Address - Street 2:
Mailing Address - City:LAGO VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78645-0010
Mailing Address - Country:US
Mailing Address - Phone:512-466-0472
Mailing Address - Fax:512-466-0472
Practice Address - Street 1:312 VENTURE BLVD S
Practice Address - Street 2:
Practice Address - City:POINT VENTURE
Practice Address - State:TX
Practice Address - Zip Code:78645
Practice Address - Country:US
Practice Address - Phone:512-466-0472
Practice Address - Fax:512-466-0472
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR0580OtherTEXAS LICENSE NUMBER
TXR0580OtherTEXAS LICENSE NUMBER