Provider Demographics
NPI:1972938108
Name:DR JAVIER LUGO MD INC
Entity type:Organization
Organization Name:DR JAVIER LUGO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:G
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-263-4133
Mailing Address - Street 1:4081 TAMIAMI TRL N
Mailing Address - Street 2:SUITE C101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-8738
Mailing Address - Country:US
Mailing Address - Phone:239-263-4133
Mailing Address - Fax:239-263-4189
Practice Address - Street 1:4081 TAMIAMI TRL N
Practice Address - Street 2:SUITE C101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8738
Practice Address - Country:US
Practice Address - Phone:239-263-4133
Practice Address - Fax:239-263-4189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65726261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty