Provider Demographics
NPI:1225061187
Name:JUGO, FELIPE EVANGELISTA (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:EVANGELISTA
Last Name:JUGO
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:PO BOX 450
Mailing Address - Street 2:401 SIXTH AVE SUITE 304B
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-0450
Mailing Address - Country:US
Mailing Address - Phone:304-442-5231
Mailing Address - Fax:
Practice Address - Street 1:401 6TH AVE STE 304B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2116
Practice Address - Country:US
Practice Address - Phone:304-442-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721772OtherBLUE CROSS BLUE SHIELD
WV0127530000Medicaid
WVJU0413301Medicare ID - Type Unspecified
WVD49231Medicare UPIN