Healthcare Provider Details

I. General information

NPI: 1528174893
Provider Name (Legal Business Name): MARK J HUGHES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 NW 4TH
REDMOND OR
97756
US

IV. Provider business mailing address

PO BOX 460
REDMOND OR
97756
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-0119
  • Fax: 541-923-3228
Mailing address:
  • Phone: 541-923-0119
  • Fax: 541-923-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberOS0009532
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO27544
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: