MEDICARE: KEITH K PUGH RPSGT

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	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist	5281	NY

General Provider Information

NPI Number	:	1982796827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH K PUGH RPSGT

Provider Business Mailing Address
First Line	:	1015 ONTARIO ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-2073
Country	:	US
Telephone Number	:	904-387-6606
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 ONTARIO ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32254-2073
Country	:	US
Telephone Number	:	904-387-6606
Fax Number	:

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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