MEDICARE: JULIAN GABRIEL LUGO PICO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	65162	TN
2	390200000X	Student in an Organized Health Care Education/Training Program		FL
3	207X00000X	Orthopaedic Surgery Physician	88016	GA

General Provider Information

NPI Number	:	1811398035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIAN GABRIEL LUGO PICO MD

Provider Business Mailing Address
First Line	:	3841 GREEN HILLS VILLAGE DR STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2691
Country	:	US
Telephone Number	:	615-225-0003
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 THE VANDERBILT CLINIC
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-2315
Country	:	US
Telephone Number	:	615-322-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2014
Last Update Date	:	08/24/2022

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