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:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:575-769-7577
Mailing Address - Fax:
Practice Address - Street 1:2421 W 21ST ST
Practice Address - Street 2:STE B
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:757-697-5775
Practice Address - Fax:575-742-7856
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2022-1422208600000X
SC274172086X0206X
NC2005-004982086X0206X
NY1453322086X0206X
GA838542086X0206X
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