Healthcare Provider Details

I. General information

NPI: 1538145545
Provider Name (Legal Business Name): GASPAR LUGO PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN SALVADOR MARGINAL E1-8
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 542
MANATI PR
00674-0542
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-4345
  • Fax: 787-854-4345
Mailing address:
  • Phone: 787-854-4345
  • Fax: 787-854-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number4054
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier3704054
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPHYSICIAN
# 2
Identifier6902
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPHYSICIAN
# 3
Identifier24659
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPHYSICIAN
# 4
Identifier064640LU
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPHYSICIAN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: