Provider Demographics
NPI:1003386020
Name:PUGH, TERRY
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58025 GAY ST
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-4221
Mailing Address - Country:US
Mailing Address - Phone:225-725-0435
Mailing Address - Fax:
Practice Address - Street 1:11616 SOUTHFORK AVE STE 401
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-5241
Practice Address - Country:US
Practice Address - Phone:225-776-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator