Provider Demographics
NPI:1962489427
Name:PUGH, DARRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:
Last Name:PUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 LAUREL MANOR DR STE 210
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5602
Mailing Address - Country:US
Mailing Address - Phone:352-350-8800
Mailing Address - Fax:844-388-6186
Practice Address - Street 1:1950 LAUREL MANOR DR STE 210
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5602
Practice Address - Country:US
Practice Address - Phone:352-350-8800
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2758326-00Medicaid
AL0-09937954Medicaid
FL2758326-00Medicaid
FLAA994WMedicare PIN