Provider Demographics
NPI:1366449555
Name:HUGHSTON, MITCHELL B (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:B
Last Name:HUGHSTON
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 1:1713 TREASURE HILLS BLVD
Mailing Address - Street 2:STE 1D
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8917
Mailing Address - Country:US
Mailing Address - Phone:956-425-8545
Mailing Address - Fax:956-412-0160
Practice Address - Street 1:1713 TREASURE HILLS BLVD
Practice Address - Street 2:STE 1D
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8917
Practice Address - Country:US
Practice Address - Phone:956-425-8545
Practice Address - Fax:956-412-0160
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122689601Medicaid
TXH1377OtherSTATE LICENSE
TX89161BMedicare ID - Type Unspecified
TXD87451Medicare UPIN