Provider Demographics
NPI:1801866322
Name:LUGO, RAUL NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:NELSON
Last Name:LUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:702 ANNA WAY
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-9101
Mailing Address - Country:US
Mailing Address - Phone:864-580-8033
Mailing Address - Fax:864-400-9715
Practice Address - Street 1:702 ANNA WAY
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-9101
Practice Address - Country:US
Practice Address - Phone:864-580-8033
Practice Address - Fax:864-400-9715
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83854208600000X, 2086X0206X
SC274172086X0206X
NC2005-004982086X0206X
NY1453322086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD91690Medicare UPIN
NY02F391Medicare ID - Type Unspecified
NY05299GMedicare ID - Type Unspecified
SCAA09638292Medicare ID - Type Unspecified
SCD91690Medicare UPIN