Provider Demographics
NPI:1528174893
Name:HUGHES, MARK J (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:HUGHES
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:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756
Mailing Address - Country:US
Mailing Address - Phone:541-923-0119
Mailing Address - Fax:541-923-3228
Practice Address - Street 1:645 NW 4TH
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756
Practice Address - Country:US
Practice Address - Phone:541-923-0119
Practice Address - Fax:541-923-3228
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0009532207PT0002X
ORDO27544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
309049OtherHEALTHEASE
309049OtherSTAYWELL
FL272958000Medicaid
FL28768OtherBCBS
309049OtherWELLCARE
309049OtherWELLCARE
FL28768OtherBCBS