Provider Demographics
NPI:1275804155
Name:HUGHES, CLARENCE O (MD)
Entity Type:Individual
Prefix:PROF
First Name:CLARENCE
Middle Name:O
Last Name:HUGHES
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 1:1850 JADE DR.
Mailing Address - Street 2:PO BOX 9
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-0009
Mailing Address - Country:US
Mailing Address - Phone:907-235-4229
Mailing Address - Fax:907-235-1936
Practice Address - Street 1:1850 JADE DR.
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-0009
Practice Address - Country:US
Practice Address - Phone:907-235-4229
Practice Address - Fax:907-235-1936
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301024644207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine