Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO2626 | FL |
NPI | 1598182628 |
---|---|
Provider Name | Josephine A. Lucas |
First Address | Oldsmar, FL 34677-4843 |
Second Address | Safety Harbor, FL 34695-5350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 26/03/2014 |