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NPI Code Detail

MEDICARE: JEFF L PUGACH MD

MEDICARE: JEFF L PUGACH MD
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
12088P0231XPediatric Urology PhysicianL3077TX

General Provider Information

NPI Number : 1871589978
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFF L PUGACH MD
Provider Business Mailing Address
First Line : PO BOX 733784
Second Line :
City : DALLAS
State : TX
Zip : 75373-3784
Country : US
Telephone Number : 682-885-1855
Fax Number : 682-885-1396
Provider Business Practice Location Address
First Line : 750 8TH AVE FL 6
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2515
Country : US
Telephone Number : 682-303-0376
Fax Number : 682-303-0377
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2005
Last Update Date : 04/13/2021

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Directions to “ JEFF L PUGACH MD” Practice Location

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