Provider Demographics
NPI:1104866672
Name:HUGHES, BRYAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:C
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 1:14310 E 42ND ST S STE 600
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7308
Mailing Address - Country:US
Mailing Address - Phone:816-333-9200
Mailing Address - Fax:772-621-2029
Practice Address - Street 1:14310 E 42ND ST S STE 600
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7308
Practice Address - Country:US
Practice Address - Phone:816-333-9200
Practice Address - Fax:772-621-2029
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006009612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006009612OtherSTATE MEDICAL LICENSE
MOF88000012Medicare PIN
MOY36000023Medicare PIN