Provider Demographics
NPI:1629616628
Name:PUGH, TAMICA
Entity Type:Individual
Prefix:
First Name:TAMICA
Middle Name:
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMICA
Other - Middle Name:
Other - Last Name:FELDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11706 N MARIANNE CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-3414
Mailing Address - Country:US
Mailing Address - Phone:832-884-7137
Mailing Address - Fax:
Practice Address - Street 1:11730 N MARIANNE CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-3414
Practice Address - Country:US
Practice Address - Phone:832-884-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17064586172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver