Provider Demographics
NPI:1841267945
Name:HUGHES, THOMAS IRA (PA-C, MPAS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:IRA
Last Name:HUGHES
Suffix:
Gender:M
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:FORKS
Mailing Address - State:WA
Mailing Address - Zip Code:98331-0720
Mailing Address - Country:US
Mailing Address - Phone:360-374-5470
Mailing Address - Fax:
Practice Address - Street 1:74 BOGACHIEL
Practice Address - Street 2:CLALLAM BAY MEDICAL CLINIC
Practice Address - City:CLALLAM BAY
Practice Address - State:WA
Practice Address - Zip Code:98326
Practice Address - Country:US
Practice Address - Phone:360-963-2202
Practice Address - Fax:360-963-2905
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8208977Medicaid
WAS57494Medicare UPIN
WAAB21304Medicare ID - Type Unspecified