Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 63027 | CA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | S-991 | LA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 311638 | LA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A158305 | CA |
NPI | 1588078224 |
---|---|
Provider Name | Ricardo Lugo |
First Address | Shreveport, LA 71103-4228 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 24/07/2019 |