Provider Demographics
NPI:1952394199
Name:LUGO, GERARDO J (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:J
Last Name:LUGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERARDO
Other - Middle Name:J
Other - Last Name:LUGO-JANER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4085 TAMIAMI TRL N
Mailing Address - Street 2:SUITE B203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-8735
Mailing Address - Country:US
Mailing Address - Phone:239-261-3082
Mailing Address - Fax:239-261-1035
Practice Address - Street 1:4085 TAMIAMI TRL N
Practice Address - Street 2:SUITE B203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8735
Practice Address - Country:US
Practice Address - Phone:239-261-3082
Practice Address - Fax:239-261-1035
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0053679207N00000X
FLME53679207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
14961OtherBLUE CROSS
FL39014Medicare ID - Type Unspecified
14961OtherBLUE CROSS