Healthcare Provider Details

I. General information

NPI: 1083819361
Provider Name (Legal Business Name): ENRIQUE RAFAEL MARTINEZ LUGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PARK PLACE BLVD STE C
DAVENPORT FL
33837-6868
US

IV. Provider business mailing address

PO BOX 878
DAVENPORT FL
33836-0878
US

V. Phone/Fax

Practice location:
  • Phone: 863-588-4775
  • Fax: 863-422-7664
Mailing address:
  • Phone: 689-223-3898
  • Fax: 689-223-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: