Provider Demographics
NPI:1083608517
Name:LUGO-RODRIGUEZ, JORGE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:E
Last Name:LUGO-RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 AVE MUNOZ RIVERA
Mailing Address - Street 2:OFICINA 606
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5015
Mailing Address - Country:US
Mailing Address - Phone:787-765-9563
Mailing Address - Fax:787-765-9563
Practice Address - Street 1:1056 AVE MUNOZ RIVERA
Practice Address - Street 2:OFICINA 606
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00927-5015
Practice Address - Country:US
Practice Address - Phone:787-765-9563
Practice Address - Fax:787-765-9563
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1919207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-77997Medicare UPIN
PR0092653Medicare PIN