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NPI Code Detail

MEDICARE: DIANE L PUGH DO

MEDICARE: DIANE L PUGH DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS0006117FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OS0006117OTHERFLMEDICAL LICENSE

General Provider Information

NPI Number : 1073590667
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE L PUGH DO
Provider Business Mailing Address
First Line : 6101 BLUE LAGOON DR STE 400
Second Line :
City : MIAMI
State : FL
Zip : 33126-2051
Country : US
Telephone Number : 305-500-2000
Fax Number :
Provider Business Practice Location Address
First Line : 1215 S 25TH ST
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-4702
Country : US
Telephone Number : 772-468-5925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2005
Last Update Date : 02/24/2026

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