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General NPI Number Information
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NPI Number | 1609961168
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Entity Type | Organization
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Legal Business Name | SAMUEL LUGO M.D., F.A.C.S.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 5213 HAMPTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63109-3170
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Country | US
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Telephone | 314-646-0478
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Fax |
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Provider Business Mailing Address
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Address Line | 5213 HAMPTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63109-3170
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Country | US
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Telephone | 314-646-0478
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL LUGO
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Credential | M.D.
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Telephone | 314-646-0478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 28888
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License Number State | MO
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