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General NPI Number Information
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NPI Number | 1710365382
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Entity Type | Organization
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Legal Business Name | MARY ANNETTE PUGH MD, PLLC
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Dates
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Enumeration Date | 05/14/2015
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 2500 HIGHWAY 65 S
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City | CLINTON
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State | AR
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Zip | 72031-6588
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Country | US
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Telephone | 479-979-8064
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Fax | 479-219-5500
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Provider Business Mailing Address
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Address Line | PO BOX 9178
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-9178
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Country | US
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Telephone | 800-824-4094
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Fax | 479-968-1643
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MARY PUGH
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Credential | MD
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Telephone | 479-806-4290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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