Provider Demographics
NPI:1114009289
Name:PUGH, DANNY P
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:P
Last Name:PUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-1078
Mailing Address - Country:US
Mailing Address - Phone:903-675-5781
Mailing Address - Fax:903-677-1008
Practice Address - Street 1:115 MEDICAL CIR
Practice Address - Street 2:SUITE 107
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9004
Practice Address - Country:US
Practice Address - Phone:903-675-5781
Practice Address - Fax:903-677-1008
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9980208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037156901Medicaid
804408Medicare ID - Type Unspecified
C20717Medicare UPIN