=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528060399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH BRIAN PUGAR D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2005
-----------------------------------------------------
Last Update Date | 07/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1975 MIAMISBURG CENTERVILLE RD
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-3811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-439-6186
-----------------------------------------------------
Fax | 937-439-9900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1975 MIAMISBURG CENTERVILLE RD
-----------------------------------------------------
City | CENTERVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-3811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-439-6186
-----------------------------------------------------
Fax | 937-439-9900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 34-00-4738-P
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------