Provider Demographics
NPI:1770582223
Name:LUGO, JOSEPH GREGORY (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GREGORY
Last Name:LUGO
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 122152 DEPT 2152
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2152
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:1717 OAK PARK BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8990
Practice Address - Country:US
Practice Address - Phone:337-494-6799
Practice Address - Fax:337-430-6950
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302965208G00000X
MO2002012685208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.302965OtherSTATE MEDICAL LICENSE
LA2426974Medicaid
MO203851118Medicaid
LAMD.302965OtherSTATE MEDICAL LICENSE