Provider Demographics
NPI:1780840926
Name:PUGH, BRIAN (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:PUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 MIDDLE CREEK RD
Mailing Address - Street 2:STE 210
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5015
Mailing Address - Country:US
Mailing Address - Phone:865-446-9550
Mailing Address - Fax:865-446-9551
Practice Address - Street 1:744 MIDDLE CREEK RD
Practice Address - Street 2:STE 210
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5015
Practice Address - Country:US
Practice Address - Phone:865-446-9550
Practice Address - Fax:865-446-9551
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.002763390200000X
TN2534208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH58.002763OtherMEDICAL LICENSE
TN1532633Medicaid
TN103I058177Medicare PIN