Provider Demographics
NPI:1770562779
Name:HUGHES, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:HUGHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:MAKATO CLINIC LTD 1230 EAST MAIN STREET
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1230 E MAIN ST
Practice Address - Street 2:MANKATO CLINIC @ MAIN STREET
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5066
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN28520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080067841OtherRR MEDICARE
IA938068Medicaid
MN0101162OtherMEDICA
410849339 56001 C032OtherCHAMPUS
MNNA2951023840OtherPREFERRED ONE
MN121158OtherU CARE
MNHP25587OtherHEALTH PARTNERS
MN1566351OtherAMERICAS PPO
MN900873000Medicaid
MN75046HUOtherBC BS
MN121158OtherU CARE
MN900873000Medicaid