Provider Demographics
NPI:1477979011
Name:PUGH, DEMETRIUS
Entity Type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:
Last Name:PUGH
Suffix:
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 1:1919 E 2ND ST
Mailing Address - Street 2:APT 294
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6219
Mailing Address - Country:US
Mailing Address - Phone:405-596-1123
Mailing Address - Fax:
Practice Address - Street 1:1919 E 2ND ST
Practice Address - Street 2:APT 294
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6219
Practice Address - Country:US
Practice Address - Phone:405-596-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health