Provider Demographics
NPI:1194859389
Name:PUGH, KRISTOPHER R (MD)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:R
Last Name:PUGH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:302 W 14TH ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3751
Mailing Address - Country:US
Mailing Address - Phone:812-284-0660
Mailing Address - Fax:812-284-3822
Practice Address - Street 1:302 W 14TH ST STE 100A
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3751
Practice Address - Country:US
Practice Address - Phone:812-284-0660
Practice Address - Fax:812-284-3822
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2020-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01063922A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN244560EMedicare PIN