Healthcare Provider Details

I. General information

NPI: 1174679799
Provider Name (Legal Business Name): THOMAS PUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 MILE HIGH STADIUM CIR
DENVER CO
80211-5222
US

IV. Provider business mailing address

2777 MILE HIGH STADIUM CIR
DENVER CO
80211-5222
US

V. Phone/Fax

Practice location:
  • Phone: 303-825-8822
  • Fax: 303-825-4022
Mailing address:
  • Phone: 303-825-8822
  • Fax: 303-825-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberN5953
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDR.0056012
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: