Healthcare Provider Details

I. General information

NPI: 1619062734
Provider Name (Legal Business Name): LARRY C HUGHES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MCCLINTIC DR
GROESBECK TX
76642-2128
US

IV. Provider business mailing address

701 MCCLINTIC DR
GROESBECK TX
76642-2128
US

V. Phone/Fax

Practice location:
  • Phone: 254-729-3411
  • Fax: 254-729-3258
Mailing address:
  • Phone: 254-729-3411
  • Fax: 254-729-3258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ1692
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: