Individual
DIANE L PUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1215 S 25TH ST, FORT PIERCE, FL 34947-4702
(772) 468-5925
Mailing address
6101 BLUE LAGOON DR STE 400, MIAMI, FL 33126-2051
(305) 500-2000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS0006117
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80576
BLUE CROSS BLUE SHIELD
FL
01
—
OS0006117
MEDICAL LICENSE
FL
01
—
P01744365
RR MEDICARE
FL
Enumeration date
12/27/2005
Last updated
02/24/2026
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