Provider Demographics
NPI:1699165860
Name:HUGHES CENTER FOR FUNCTIONAL MEDICINE PA
Entity type:Organization
Organization Name:HUGHES CENTER FOR FUNCTIONAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-649-7400
Mailing Address - Street 1:800 GOODLETTE RD N
Mailing Address - Street 2:SUITE 270
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5400
Mailing Address - Country:US
Mailing Address - Phone:239-649-7400
Mailing Address - Fax:239-649-6370
Practice Address - Street 1:800 GOODLETTE RD N
Practice Address - Street 2:SUITE 270
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5400
Practice Address - Country:US
Practice Address - Phone:239-649-7400
Practice Address - Fax:239-649-6370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 12978208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty