Provider Demographics
NPI:1023005808
Name:PUGH, BRIAN W (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:W
Last Name:PUGH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6028 S RIDGELINE DR
Mailing Address - Street 2:STE 201
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6914
Mailing Address - Country:US
Mailing Address - Phone:801-475-5400
Mailing Address - Fax:801-475-8614
Practice Address - Street 1:6028 S RIDGELINE DR
Practice Address - Street 2:STE 201
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6914
Practice Address - Country:US
Practice Address - Phone:801-475-5400
Practice Address - Fax:801-475-8614
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2010-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT3619881204207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2900043OtherUNITED HEALTHCARE
UT870653164002Medicaid
107008467101OtherIHC
107008467101OtherIHC
UT870653164002Medicaid