Provider Demographics
NPI:1093919672
Name:PUGH, MARK H (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:PUGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5096 MIDDLETON PL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1406
Mailing Address - Country:US
Mailing Address - Phone:606-748-2523
Mailing Address - Fax:
Practice Address - Street 1:1030 MONARCH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1843
Practice Address - Country:US
Practice Address - Phone:606-748-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM58902084P0800X
KY036482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187757303Medicaid
688088853OtherMYUTMB 688088853-COMMERCIAL NUMBER
TX8L8273Medicare PIN