Provider Demographics
NPI:1164583043
Name:PUGH, KENNETH GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:GREGORY
Last Name:PUGH
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 1:401 SW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-7603
Mailing Address - Country:US
Mailing Address - Phone:301-661-5076
Mailing Address - Fax:
Practice Address - Street 1:401 SW 33RD AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-7603
Practice Address - Country:US
Practice Address - Phone:301-661-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050097207RG0300X
FLME138875207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine