Organization Name: | MARY ANNETTE PUGH MD, PLLC |
NPI Number: | 1710365382 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY PUGH (AUTHORIZED OFFICIAL) |
Mailing Address: | 200 N 3rd St Dardanelle |
State: | AR US |
Postal Code: | 728343802 |
Phone Number: | 4792296191 |
Fax Number: | |
NPI Enumeration Date: | 05/14/2015 |
NPI Last Update Date: | 05/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |