Provider Demographics
NPI:1306395793
Name:RAFAEL A LUGO MD PA
Entity Type:Organization
Organization Name:RAFAEL A LUGO MD PA
Other - Org Name:LUGO SURGICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-656-8465
Mailing Address - Street 1:10800 GOSLING RD UNIT 131330
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-4064
Mailing Address - Country:US
Mailing Address - Phone:832-656-8465
Mailing Address - Fax:888-416-9722
Practice Address - Street 1:17189 INTERSTATE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8309208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031168004Medicaid