Healthcare Provider Details

I. General information

NPI: 1518147842
Provider Name (Legal Business Name): JOSH MIKEL PUGH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S 12TH ST
MURRAY KY
42071-9303
US

IV. Provider business mailing address

1000 S 12TH ST
MURRAY KY
42071-9303
US

V. Phone/Fax

Practice location:
  • Phone: 270-767-3125
  • Fax: 270-759-9966
Mailing address:
  • Phone: 270-767-3125
  • Fax: 270-759-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1042
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000001594
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: