Provider Demographics
NPI:1861546681
Name:LARRY C HUGHES MD INC A MEDICAL CORPORATION
Entity type:Organization
Organization Name:LARRY C HUGHES MD INC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-925-9565
Mailing Address - Street 1:4020 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-5279
Mailing Address - Country:US
Mailing Address - Phone:951-925-9565
Mailing Address - Fax:
Practice Address - Street 1:4020 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-5279
Practice Address - Country:US
Practice Address - Phone:951-925-9565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59842207QA0000X, 207Q00000X
G59842207QA0505X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G598421Medicaid
080022933OtherRAILROAD MEDICARE
CA00G598420Medicaid
CA1679659254OtherRENDERING LINK NPI
CAZZZ30159ZOtherMPTANGRP
CA00G598420Medicaid
CA00G598420Medicare ID - Type Unspecified
CAZZZ30159ZMedicare ID - Type Unspecified