Active NPI
J. Enrique Lujan, M.D.
- Pediatrics Physician
- Crestview, FL
National Provider Identifier
1083748719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 54171
- Practice address
- 160 E Redstone Ave
Crestview, FL 32539-5348 - Phone
- (850) 689-0555
- Fax
- (850) 689-3531
- NPI assigned
- Mar 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 54171 | FL | Primary |
Addresses
Primary practice location
160 E Redstone Ave
Crestview, FL 32539-5348
Mailing address
160 E Redstone Ave
Crestview, FL 32539-5348
Phone (850) 689-0555
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07962 | Other | FL | BC BS PROVIDER NO. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54171 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Enrique Lujan | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Crestview, FL
- NPI 1629102389
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1083748719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 E REDSTONE AVE",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325395348",
"telephone_number": "850-689-0555",
"fax_number": "850-689-3531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 E REDSTONE AVE",
"city": "CRESTVIEW",
"state": "FL",
"postal_code": "325395348",
"telephone_number": "850-689-0555",
"fax_number": "850-689-3531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUJAN",
"first_name": "J.",
"middle_name": "ENRIQUE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "54171",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS PROVIDER NO.",
"identifier": "07962",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Crestview, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.