Provider Demographics
NPI:1518966902
Name:PUGH, PEGGY ANN (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:ANN
Last Name:PUGH
Suffix:
Gender:F
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:DEPT LA 21555
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1555
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:800-409-7005
Practice Address - Street 1:ONE HOAG DRIVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-645-3534
Practice Address - Fax:800-409-7005
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG577202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518966902Medicaid
00G577200OtherBLUE SHIELD OF CA
00G577200Q92OtherCALOPTIMA
300123286OtherRAILROAD MEDICARE
CA00G577200Medicaid
CA1518966902Medicaid
CA00G577200Medicaid
WG57720PMedicare PIN
CACL496VMedicare PIN