Healthcare Provider Details

I. General information

NPI: 1841267945
Provider Name (Legal Business Name): THOMAS IRA HUGHES PA-C, MPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 BOGACHIEL CLALLAM BAY MEDICAL CLINIC
CLALLAM BAY WA
98326
US

IV. Provider business mailing address

PO BOX 720
FORKS WA
98331-0720
US

V. Phone/Fax

Practice location:
  • Phone: 360-963-2202
  • Fax: 360-963-2905
Mailing address:
  • Phone: 360-374-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10003261
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: