Provider Demographics
NPI:1013437706
Name:HOUGH, ERIN (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HOUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CYPRESS EDGE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8454
Mailing Address - Country:US
Mailing Address - Phone:386-589-4462
Mailing Address - Fax:
Practice Address - Street 1:120 CYPRESS EDGE DR STE 202
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8454
Practice Address - Country:US
Practice Address - Phone:386-589-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25064207Q00000X
FLME137937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102225400Medicaid