Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 15687 | CO |
NPI | 1033354386 |
---|---|
Provider Name | Dr. Madison Jerome Lucas I |
First Address | Morrison, CO 80465-2219 |
Second Address | Morrison, CO 80465-2219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 19/12/2008 |