Healthcare Provider Details

I. General information

NPI: 1770582223
Provider Name (Legal Business Name): JOSEPH GREGORY LUGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 OAK PARK BLVD FL 2
LAKE CHARLES LA
70601-8990
US

IV. Provider business mailing address

PO BOX 122152 DEPT 2152
DALLAS TX
75312-2152
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-6799
  • Fax: 337-430-6950
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number302965
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: