Provider Demographics
NPI:1699797571
Name:MCHUGH, BERNIE G JR (MD)
Entity type:Individual
Prefix:DR
First Name:BERNIE
Middle Name:G
Last Name:MCHUGH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 GRAMMONT ST STE 404
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7403
Mailing Address - Country:US
Mailing Address - Phone:318-323-1809
Mailing Address - Fax:318-323-2668
Practice Address - Street 1:312 GRAMMONT ST STE 404
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7403
Practice Address - Country:US
Practice Address - Phone:318-323-1809
Practice Address - Fax:318-323-2668
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021731207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1429112Medicaid
LA1429112Medicaid
LA5H343CE50Medicare PIN