Provider Demographics
NPI:1639153281
Name:PUGEDA, JAIME G (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:G
Last Name:PUGEDA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1901 S CEDAR ST
Mailing Address - Street 2:SUITE 301 CARDIAC STUDY CENTER, INC., P.S.
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2308
Mailing Address - Country:US
Mailing Address - Phone:253-572-7320
Mailing Address - Fax:253-627-3191
Practice Address - Street 1:1901 S CEDAR ST
Practice Address - Street 2:SUITE 301 CARDIAC STUDY CENTER, INC., P.S.
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2308
Practice Address - Country:US
Practice Address - Phone:253-572-7320
Practice Address - Fax:253-627-3191
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00042277207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8356412Medicaid
H83469Medicare UPIN
WA8356412Medicaid