Provider Demographics
NPI:1588663504
Name:HUGHES, DOUGLAS MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MARK
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11695
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-1695
Mailing Address - Country:US
Mailing Address - Phone:386-425-4139
Mailing Address - Fax:389-425-7898
Practice Address - Street 1:HALIFX MEDICAL CENTER
Practice Address - Street 2:303 N CLYDE MORRIS BLVD
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1838
Practice Address - Country:US
Practice Address - Phone:386-425-4139
Practice Address - Fax:386-425-7898
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97663207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
220030572OtherRAILROAD MEDICARE
VA006606423Medicaid
220030572OtherRAILROAD MEDICARE
VA006606423Medicaid