Healthcare Provider Details

I. General information

NPI: 1043204704
Provider Name (Legal Business Name): KEVIN J. PUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E CHEVES ST
FLORENCE SC
29506-2707
US

IV. Provider business mailing address

1005 E CHEVES ST
FLORENCE SC
29506-2707
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7900
  • Fax: 843-777-7925
Mailing address:
  • Phone: 843-777-7900
  • Fax: 843-777-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMC-2827
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number35-059085
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number83008
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number65356
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: