Provider Demographics
NPI:1235233842
Name:PUGH, JACQUELINE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ANN
Last Name:PUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11321 FALLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4232
Mailing Address - Country:US
Mailing Address - Phone:832-237-3500
Mailing Address - Fax:832-237-0200
Practice Address - Street 1:7863 CALLAGHAN RD
Practice Address - Street 2:SUITE 206
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2453
Practice Address - Country:US
Practice Address - Phone:832-237-3500
Practice Address - Fax:832-237-0200
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9981207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044130502Medicaid
TX8K4684Medicare PIN