Provider Demographics
NPI:1003895681
Name:HUGHES, GORDON M (MD)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:M
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4529
Mailing Address - Country:US
Mailing Address - Phone:765-281-2000
Mailing Address - Fax:765-281-2062
Practice Address - Street 1:303 S NAPPANEE ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2098
Practice Address - Country:US
Practice Address - Phone:574-296-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035437A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100107080Medicaid
IN110035800OtherMEDICARE B-RAILROAD
IN465610WMedicare ID - Type Unspecified
IN110035800OtherMEDICARE B-RAILROAD