Healthcare Provider Details

I. General information

NPI: 1225033152
Provider Name (Legal Business Name): EVERARD HUDSON HUGHES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

IV. Provider business mailing address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-3360
  • Fax: 760-499-3361
Mailing address:
  • Phone: 760-499-3360
  • Fax: 760-499-3361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number04-28775
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberG32722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: