Provider Demographics
NPI:1053719898
Name:MATTHEW DOUGLAS PUGH, D.O.
Entity type:Organization
Organization Name:MATTHEW DOUGLAS PUGH, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-482-4333
Mailing Address - Street 1:754 MEDICAL CENTER CT
Mailing Address - Street 2:206
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6654
Mailing Address - Country:US
Mailing Address - Phone:619-482-4333
Mailing Address - Fax:619-482-4445
Practice Address - Street 1:754 MEDICAL CENTER CT
Practice Address - Street 2:206
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6654
Practice Address - Country:US
Practice Address - Phone:619-482-4333
Practice Address - Fax:619-482-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12102207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty