Provider Demographics
NPI:1487630174
Name:HUGHES, EDWARD C JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:HUGHES
Suffix:JR
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 1:5140 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1658
Mailing Address - Country:US
Mailing Address - Phone:707-864-6144
Mailing Address - Fax:707-864-9075
Practice Address - Street 1:5140 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1658
Practice Address - Country:US
Practice Address - Phone:707-864-6144
Practice Address - Fax:707-864-9075
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G563130Medicaid
CAG56313OtherCA MED BOARD
CAG56313OtherCA MED BOARD
CA00G563130Medicaid