Provider Demographics
NPI:1073574935
Name:HUGHES, JONATHAN HOWARD (MD PHD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:HOWARD
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 S MARYLAND PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-6209
Mailing Address - Country:US
Mailing Address - Phone:702-732-3441
Mailing Address - Fax:702-732-2310
Practice Address - Street 1:3059 S MARYLAND PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-6209
Practice Address - Country:US
Practice Address - Phone:702-732-3441
Practice Address - Fax:702-732-2310
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8970207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV200225017Medicaid
NVV32409Medicare PIN
NVP00377262Medicare PIN
G50262Medicare UPIN