Glen Thomas Pugh, N.P.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP14609 Issued in CA

Practice address

555 E Valley Pkwy
Escondido, CA 92025-3048

Phone

(760) 739-3199

Fax

(760) 739-3882

NPI assigned

Sep 25, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194220800000",
    "number": "1083801955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 E VALLEY PKWY",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253048",
            "telephone_number": "760-739-3199",
            "fax_number": "760-739-3882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E VALLEY PKWY",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253048",
            "telephone_number": "760-739-3199",
            "fax_number": "760-739-3882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUGH",
        "first_name": "GLEN",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-25",
        "last_updated": "2007-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP14609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Escondido, CA
• Providers in Escondido, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.