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General NPI Number Information
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NPI Number | 1194178673
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Entity Type | Individual
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Provider Name | EDRICK GABRIEL LUGO MILLAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 400 HEALTH PARK BLVD
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5784
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Country | US
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Telephone | 904-819-5155
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55310
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City | BIRMINGHAM
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State | AL
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Zip | 35255-5310
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME168824
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 44248
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 22388
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License Number State | PR
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