Healthcare Provider Details

I. General information

NPI: 1003856907
Provider Name (Legal Business Name): MARK HUGHES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 HOLIDAY ST NW
CANTON OH
44718-2531
US

IV. Provider business mailing address

4105 HOLIDAY ST NW
CANTON OH
44718-2531
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-2097
  • Fax: 330-494-9750
Mailing address:
  • Phone: 330-494-2097
  • Fax: 330-494-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50001086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: