MEDICARE: PEGGY ANN PUGH 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	2085R0202X	Diagnostic Radiology Physician	G57720	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	300123286	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00G577200	OTHER	BLUE SHIELD OF CA
3	00G577200Q92	OTHER	CALOPTIMA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518966902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEGGY ANN PUGH M.D.

Provider Business Mailing Address
First Line	:	DEPT LA 21555
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91185-1555
Country	:	US
Telephone Number	:	949-263-8620
Fax Number	:	800-409-7005

Provider Business Practice Location Address
First Line	:	ONE HOAG DRIVE
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92663-4162
Country	:	US
Telephone Number	:	949-645-3534
Fax Number	:	800-409-7005

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	06/13/2012

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Directions to “ PEGGY ANN PUGH M.D.” Practice Location

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