Provider Demographics
NPI:1346009586
Name:PUGH, ALGENON JR
Entity Type:Individual
Prefix:MR
First Name:ALGENON
Middle Name:
Last Name:PUGH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20341 BALL AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2723
Mailing Address - Country:US
Mailing Address - Phone:216-320-7410
Mailing Address - Fax:
Practice Address - Street 1:20341 BALL AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2723
Practice Address - Country:US
Practice Address - Phone:216-320-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals