Provider Demographics
NPI:1295764280
Name:LUGIBIHL, JAY RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:RICHARD
Last Name:LUGIBIHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29627 ST. RT. 30
Mailing Address - Street 2:P.O. BOX 195
Mailing Address - City:HANOVERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44423
Mailing Address - Country:US
Mailing Address - Phone:330-223-1547
Mailing Address - Fax:330-223-1911
Practice Address - Street 1:29627 ST. RT. 30
Practice Address - Street 2:
Practice Address - City:HANOVERTON
Practice Address - State:OH
Practice Address - Zip Code:44423
Practice Address - Country:US
Practice Address - Phone:330-223-1547
Practice Address - Fax:330-223-1911
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003675L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0609023Medicaid
OHE00694Medicare UPIN
OH0609023Medicaid