MEDICARE: DR. JUSTIN E. HUGO M.D.

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
1	207Q00000X	Family Medicine Physician	2004002167	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104826098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN E. HUGO M.D.

Provider Business Mailing Address
First Line	:	714 GRAVOIS RD
Second Line	:	SUITE 210
City	:	FENTON
State	:	MO
Zip	:	63026-7727
Country	:	US
Telephone Number	:	314-543-5230
Fax Number	:	314-543-5280

Provider Business Practice Location Address
First Line	:	714 GRAVOIS RD
Second Line	:	SUITE 210
City	:	FENTON
State	:	MO
Zip	:	63026-7727
Country	:	US
Telephone Number	:	314-543-5230
Fax Number	:	314-543-5280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	04/07/2010

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Directions to “ DR. JUSTIN E. HUGO M.D.” Practice Location

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