Provider Demographics
NPI:1225080575
Name:HUGHSON, DANIEL L (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:HUGHSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 CENTERPOINTE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8660
Mailing Address - Country:US
Mailing Address - Phone:503-797-2273
Mailing Address - Fax:503-234-8155
Practice Address - Street 1:1185 SOUTH ELM ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013
Practice Address - Country:US
Practice Address - Phone:503-723-4660
Practice Address - Fax:503-266-6649
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD13198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213033Medicaid
110205861OtherRR MEDICARE
ORC92918Medicare UPIN
110205861OtherRR MEDICARE