Provider Demographics
NPI:1851308340
Name:LUGO MORALES, JOSE J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:J
Last Name:LUGO MORALES
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 542
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0542
Mailing Address - Country:US
Mailing Address - Phone:787-855-1111
Mailing Address - Fax:
Practice Address - Street 1:URB ALTURAS CALLE A-B-1
Practice Address - Street 2:SUITE 4
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3425OtherPREFERRED MEDICARE CHOISE
PR100198OtherMMM
PR6740168OtherHUMANA PUERTO RICO
PR84101OtherTRIPLE C
PR101073OtherCRUZ AZUL
PR84101OtherTRIPLE S
PRA308OtherINTERNATIONAL MEDICAL CAR
PR3425OtherPREFERRED MEDICARE CHOISE
PR84101Medicare ID - Type UnspecifiedMEDICARE