MEDICARE: DR. DANNY P PUGH

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	208600000X	Surgery Physician	F9980	TX

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	:	1114009289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNY P PUGH

Provider Business Mailing Address
First Line	:	PO BOX C
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-1078
Country	:	US
Telephone Number	:	903-675-5781
Fax Number	:	903-677-1008

Provider Business Practice Location Address
First Line	:	115 MEDICAL CIR
Second Line	:	SUITE 107
City	:	ATHENS
State	:	TX
Zip	:	75751-9004
Country	:	US
Telephone Number	:	903-675-5781
Fax Number	:	903-677-1008

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/18/2012

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