Healthcare Provider Details

I. General information

NPI: 1427446491
Provider Name (Legal Business Name): MR. DONALD PUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 PATTERSON AVE STE B
RICHMOND VA
23229-6370
US

IV. Provider business mailing address

26222 RANCH ROAD 12
DRIPPING SPRINGS TX
78620-4903
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-0055
  • Fax: 804-282-4762
Mailing address:
  • Phone: 512-858-0300
  • Fax: 512-858-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101001268
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: