Healthcare Provider Details

I. General information

NPI: 1861546681
Provider Name (Legal Business Name): LARRY C HUGHES MD INC A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 W FLORIDA AVE
HEMET CA
92545-5279
US

IV. Provider business mailing address

4020 W FLORIDA AVE
HEMET CA
92545-5279
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-9565
  • Fax:
Mailing address:
  • Phone: 951-925-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG59842
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberG59842
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG59842
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG59842
License Number State

VIII. Authorized Official

Name: DR. LARRY C HUGHES
Title or Position: OWNER
Credential: M.D.
Phone: 951-925-9565