Healthcare Provider Details

I. General information

NPI: 1740262542
Provider Name (Legal Business Name): DOUGLAS S HUGHES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9351 CORKSCREW RD STE 101
ESTERO FL
33928-6801
US

IV. Provider business mailing address

9351 CORKSCREW RD STE 101
ESTERO FL
33928-6801
US

V. Phone/Fax

Practice location:
  • Phone: 239-561-5776
  • Fax: 239-333-1953
Mailing address:
  • Phone: 239-561-5776
  • Fax: 239-333-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: