Provider Demographics
NPI:1235130501
Name:LUGO, JAVIER G (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:G
Last Name:LUGO
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 1:4081 TAMIAMI TRL N
Mailing Address - Street 2:SUITE C101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-8738
Mailing Address - Country:US
Mailing Address - Phone:239-263-4133
Mailing Address - Fax:239-263-4189
Practice Address - Street 1:4081 TAMIAMI TRL N
Practice Address - Street 2:STE C101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8738
Practice Address - Country:US
Practice Address - Phone:239-263-4133
Practice Address - Fax:239-263-4189
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2008-05-13
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FL65726207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001403138014OtherUNITED HEALTHCARE
FL226789OtherSTAYWELL
FL256438OtherAVMED
FL8008907009OtherCIGNA
FL26302OtherBLUE CROSS BLUE SHIELD
FL269476000Medicaid
FL5329753OtherAETNA
FLP00203550OtherRAILROAD MEDICARE
FL26302OtherBLUE CROSS BLUE SHIELD
FL5329753OtherAETNA