MEDICARE: MR. BLAIR KENT HOUGH 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	208600000X	Surgery Physician	MD2016-0486	NM
2	208600000X	Surgery Physician	4301056501	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101364	OTHER	MI	SHN HOSPITAL GLHP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467407031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BLAIR KENT HOUGH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PHS PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 SPRUCE ST
Second Line	:	PMG ESPANOLA
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2724
Country	:	US
Telephone Number	:	505-367-0362
Fax Number	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/28/2016

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