Provider Demographics
NPI:1144249012
Name:VIRTUSIO, LOURDES L (MD)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:L
Last Name:VIRTUSIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 TOWN STREET
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505
Mailing Address - Country:US
Mailing Address - Phone:850-432-4745
Mailing Address - Fax:850-434-0395
Practice Address - Street 1:2102 TOWN STREET
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505
Practice Address - Country:US
Practice Address - Phone:850-432-4745
Practice Address - Fax:850-434-0395
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251986100Medicaid
FL32957OtherBLUE CROSS BLUE SHIELD
AL59018276OtherBLUE CROSS BLUE SHIELD
FL251986100Medicaid
FL32957OtherBLUE CROSS BLUE SHIELD