Healthcare Provider Details

I. General information

NPI: 1124330576
Provider Name (Legal Business Name): CHARLES V.O. HUGHES, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 JOHN DUPRE DR STE A
LEVELLAND TX
79336-6300
US

IV. Provider business mailing address

1804 COLLEGE AVE
LEVELLAND TX
79336-6507
US

V. Phone/Fax

Practice location:
  • Phone: 806-894-7900
  • Fax: 806-894-7631
Mailing address:
  • Phone: 806-894-3141
  • Fax: 806-894-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG2997
License Number StateTX

VIII. Authorized Official

Name: DR. CHARLES V.O. HUGHES III
Title or Position: DIRECTOR
Credential: M.D.
Phone: 806-894-7900