Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 01035437A | IN |
NPI | 1003895681 |
---|---|
Provider Name | Mr. Gordon M Hughes |
First Address | Muncie, IN 47304-4529 |
Second Address | Elkhart, IN 46514-2098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 03/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100107080 | (05) | IN |
110035800 | MEDICARE B-RAILROAD (01) | IN |
E39363 | (02) | IN |