Provider Demographics
NPI:1245224492
Name:LUGO, RAFAEL A (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
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:PO BOX 131330
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-1330
Mailing Address - Country:US
Mailing Address - Phone:832-377-5846
Mailing Address - Fax:
Practice Address - Street 1:17189 I 45 S STE 275
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3326
Practice Address - Country:US
Practice Address - Phone:832-377-5846
Practice Address - Fax:888-416-9722
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8309208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1245224492OtherBLUE CROSS BLUE SHIELD
TX87670ZOtherHMO BLUE
TX8F6737OtherBCBS
TX020053268OtherRAILROAD MEDICARE
TX031168003Medicaid
TX031168004Medicaid
TX031168005Medicaid
TX5363822OtherAETNA
TX031168002Medicaid
TX401312001Medicaid
TX1245224492OtherBLUE CROSS BLUE SHIELD
TX031168003Medicaid