MEDICARE: GABRIEL EDUARDO LUGO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0206X	Pediatric Gastroenterology Physician	ME161078	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578097085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL EDUARDO LUGO MD

Provider Business Mailing Address
First Line	:	2901 58TH AVE N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33714-1326
Country	:	US
Telephone Number	:	727-822-4300
Fax Number	:	727-456-1399

Provider Business Practice Location Address
First Line	:	6709 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6834
Country	:	US
Telephone Number	:	727-351-8121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	07/12/2023

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