Ralph David Pugh, CSFA, ROT

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

190611 Issued in FL

Practice address

1451 El Camino Real
Lady Lake, FL 32159-0041

Phone

(352) 751-8000

NPI assigned

Apr 18, 2016

Last updated

Sep 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1497109227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1451 EL CAMINO REAL",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321590041",
            "telephone_number": "352-751-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 EL CAMINO REAL",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321590041",
            "telephone_number": "352-751-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12 Morgan Ave",
            "address_purpose": "LOCATION",
            "city": "Leesburg",
            "state": "FL",
            "postal_code": "347488912",
            "country_code": "US",
            "telephone_number": "352-396-9147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUGH",
        "first_name": "RALPH",
        "middle_name": "DAVID",
        "credential": "CSFA, ROT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-18",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "190611",
            "primary": true
        },
        {
            "code": "246ZX2200X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Orthopedic Assistant",
            "state": "FL",
            "license": "040416060",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Lady Lake, FL
• Providers in Lady Lake, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; 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.