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General NPI Number Information
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NPI Number | 1578687737
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Entity Type | Individual
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Provider Name | ROBERTO LUGO M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 7710 SOUTH US HIGHWAY 1
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-2301
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Country | US
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Telephone | 772-335-5300
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Fax | 772-878-7602
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Provider Business Mailing Address
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Address Line | 7710 SOUTH US HIGHWAY 1
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-2301
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Country | US
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Telephone | 772-335-5300
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Fax | 772-878-7602
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | ME107231
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License Number State | FL
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