Provider Demographics
NPI:1982796827
Name:PUGH, KEITH K (RPSGT)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:K
Last Name:PUGH
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-2073
Mailing Address - Country:US
Mailing Address - Phone:904-387-6606
Mailing Address - Fax:
Practice Address - Street 1:1015 ONTARIO ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-2073
Practice Address - Country:US
Practice Address - Phone:904-387-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5281225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist