Healthcare Provider Details

I. General information

NPI: 1316475197
Provider Name (Legal Business Name): BRIAN M MUGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 ERWIN RD STE 200
DURHAM NC
27705-0005
US

IV. Provider business mailing address

3475 ERWIN RD STE 200
DURHAM NC
27705-0005
US

V. Phone/Fax

Practice location:
  • Phone: 919-660-6746
  • Fax: 919-684-0607
Mailing address:
  • Phone: 919-660-6746
  • Fax: 919-684-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number271081
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2024-03350
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: