Healthcare Provider Details

I. General information

NPI: 1700870847
Provider Name (Legal Business Name): MARK DOUGLAS HUGHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12920 US HIGHWAY 1 STE B
SEBASTIAN FL
32958-3772
US

IV. Provider business mailing address

12920 US HIGHWAY 1 STE B
SEBASTIAN FL
32958-3772
US

V. Phone/Fax

Practice location:
  • Phone: 772-589-0580
  • Fax: 321-841-7985
Mailing address:
  • Phone: 772-589-0580
  • Fax: 321-841-7985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME113291
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: