Provider Demographics
NPI:1962450205
Name:PUGH, THERESA JONES (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:JONES
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 1:1101 W 40TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3609
Mailing Address - Country:US
Mailing Address - Phone:512-459-4147
Mailing Address - Fax:512-459-9134
Practice Address - Street 1:1101 W 40TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3609
Practice Address - Country:US
Practice Address - Phone:512-459-4147
Practice Address - Fax:512-459-9134
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8901207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL8901OtherMEDICAL LICENSE
TX8P1160OtherBCBS TEXAS
TXR0134028OtherDPS NUMBER
TX45D0505324OtherCLIA NUMBER
TX45D0505324OtherCLIA NUMBER
TXR0134028OtherDPS NUMBER
TXI12199Medicare UPIN
TX8P1160OtherBCBS TEXAS
TX45D0505324OtherCLIA NUMBER