Provider Demographics
NPI:1013209303
Name:FABIAN LUGO MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:FABIAN LUGO MD, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:337-989-9971
Mailing Address - Street 1:PO BOX 52465
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2465
Mailing Address - Country:US
Mailing Address - Phone:337-989-9971
Mailing Address - Fax:337-989-9986
Practice Address - Street 1:913 S COLLEGE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3060
Practice Address - Country:US
Practice Address - Phone:337-989-9971
Practice Address - Fax:337-989-9986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020740207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty