Healthcare Provider Details

I. General information

NPI: 1558773457
Provider Name (Legal Business Name): JOEL HUGHES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST RM 1F325
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

301 FISHER ST RM GG712
BILOXI MS
39534-2508
US

V. Phone/Fax

Practice location:
  • Phone: 228-436-3362
  • Fax:
Mailing address:
  • Phone: 228-376-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number1438
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number1438
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number1438
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: