Healthcare Provider Details

I. General information

NPI: 1275605834
Provider Name (Legal Business Name): JOSEPH WILLIAM PUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 BROOKMEADE DR
CRESTVIEW FL
32539-7304
US

IV. Provider business mailing address

PO BOX 1027
NICEVILLE FL
32588-1027
US

V. Phone/Fax

Practice location:
  • Phone: 850-605-0550
  • Fax: 850-605-0440
Mailing address:
  • Phone: 850-605-0550
  • Fax: 850-605-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME100117
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberC154316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: