Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | ME0057701 | FL |
NPI | 1336131069 |
---|---|
Provider Name | David H Lucas |
First Address | Clermont, FL 34711 |
Second Address | Clermont, FL 34711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 02/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25344Z | MEDICARE PTAN (01) | FL |
375475800 | (05) | FL |
F61887 | (02) | FL |