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General NPI Number Information
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NPI Number | 1023005808
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Entity Type | Individual
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Provider Name | BRIAN W PUGH DO
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 6028 S RIDGELINE DR STE 201
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City | OGDEN
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State | UT
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Zip | 84405-6914
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Country | US
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Telephone | 801-475-5400
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Fax | 801-475-8614
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Provider Business Mailing Address
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Address Line | 6028 S RIDGELINE DR STE 201
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City | OGDEN
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State | UT
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Zip | 84405-6914
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Country | US
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Telephone | 801-475-5400
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Fax | 801-475-8614
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 3619881204
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License Number State | UT
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