Provider Demographics
NPI:1578687737
Name:LUGO, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
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 1:7710 SOUTH US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2301
Mailing Address - Country:US
Mailing Address - Phone:772-335-5300
Mailing Address - Fax:772-878-7602
Practice Address - Street 1:7710 SOUTH US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2301
Practice Address - Country:US
Practice Address - Phone:772-335-5300
Practice Address - Fax:772-878-7602
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107231207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL148LFOtherBCBS
FLP00891967OtherRR MCR
FL3357624OtherCIGNA
FL9818372OtherAETNA
FLP00891967OtherRR MCR
RES000Medicare UPIN