Provider Demographics
NPI:1760488233
Name:LUAGUE, SAMUEL BALANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BALANA
Last Name:LUAGUE
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 855
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-0855
Mailing Address - Country:US
Mailing Address - Phone:276-236-7166
Mailing Address - Fax:276-236-7165
Practice Address - Street 1:401 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2858
Practice Address - Country:US
Practice Address - Phone:276-236-7166
Practice Address - Fax:276-236-7165
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA25878207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC690612WOtherMEDICAID
VA6399941Medicaid
VA061584OtherANTHEM
VA061584OtherANTHEM