Healthcare Provider Details

I. General information

NPI: 1194755900
Provider Name (Legal Business Name): JOHN J HUGHES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2639 IRVING AVE S
MINNEAPOLIS MN
55408-1048
US

IV. Provider business mailing address

2639 IRVING AVE S
MINNEAPOLIS MN
55408-1048
US

V. Phone/Fax

Practice location:
  • Phone: 612-250-5662
  • Fax:
Mailing address:
  • Phone: 612-250-5662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number27146
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number12078
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: