Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 11384 | MS |
NPI | 1225060056 |
---|---|
Provider Name | Aubrey Lucas |
First Address | Flowood, MS 39232-9303 |
Second Address | Flowood, MS 39232-9303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 29/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00124978 | (05) | MS |
C61427 | (02) | MS |