Provider Demographics
NPI:1073266805
Name:PUGH, MEGAN HATTIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:HATTIE
Last Name:PUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 COMFORT LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-9139
Mailing Address - Country:US
Mailing Address - Phone:406-599-8915
Mailing Address - Fax:
Practice Address - Street 1:1208 6TH AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872-9667
Practice Address - Country:US
Practice Address - Phone:406-822-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-102686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant