Provider Demographics
NPI:1104254002
Name:PUGH, ETHO TODD SR
Entity type:Individual
Prefix:MR
First Name:ETHO
Middle Name:TODD
Last Name:PUGH
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 ROSELLE CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-2590
Mailing Address - Country:US
Mailing Address - Phone:682-554-9996
Mailing Address - Fax:
Practice Address - Street 1:1904 ROSELLE CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-2590
Practice Address - Country:US
Practice Address - Phone:682-554-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health