| Organization Name: | JERRY L LUGGER MD PA |
| NPI Number: | 1043576358 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY LEE LUGGER (PRESIDENT) |
| Mailing Address: | 461 Westpark Way Euless |
| State: | TX US |
| Postal Code: | 760403957 |
| Phone Number: | 8175401755 |
| Fax Number: | 8176857774 |
| NPI Enumeration Date: | 04/11/2012 |
| NPI Last Update Date: | 05/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | G2762 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |