Provider Demographics
NPI:1225033152
Name:HUGHES, EVERARD HUDSON JR (MD)
Entity Type:Individual
Prefix:
First Name:EVERARD
Middle Name:HUDSON
Last Name:HUGHES
Suffix:JR
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 1:1081 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3130
Mailing Address - Country:US
Mailing Address - Phone:760-499-3360
Mailing Address - Fax:760-499-3361
Practice Address - Street 1:1011 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3130
Practice Address - Country:US
Practice Address - Phone:760-499-3360
Practice Address - Fax:760-499-3361
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28775207RH0003X
CAG32722207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100369490DMedicaid
P00253469OtherRAILROAD MC
KS104879OtherMEDICARE ID
P00253469OtherRAILROAD MC
KS104879Medicare PIN
09621Medicare UPIN