Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 4301024644 | MI |
NPI | 1275804155 |
---|---|
Provider Name | Prof. Clarence O. Hughes |
First Address | Homer, AK 99603-0009 |
Second Address | Homer, AK 99603-0009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2012 |
Last Update Date | 24/01/2012 |