Provider Demographics
NPI:1245307545
Name:LUGO, ANIBAL J SR (MD)
Entity type:Individual
Prefix:
First Name:ANIBAL
Middle Name:J
Last Name:LUGO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0088
Mailing Address - Country:US
Mailing Address - Phone:787-264-3000
Mailing Address - Fax:787-892-5992
Practice Address - Street 1:EDIFICIO PLAZA METROPOLITANA
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0000
Practice Address - Country:US
Practice Address - Phone:787-264-3000
Practice Address - Fax:787-892-5994
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10754207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060053219OtherPALMETTO
060510OtherCA
310754OtherCIGNA
601504OtherMMM
6830017OtherHUMANA INSURANCE
F98952Medicare UPIN
060510OtherCA