Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME38428 | FL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME38428 | FL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME38428 | FL |
NPI | 1174527949 |
---|---|
Provider Name | Richard Stephen Lucie |
First Address | Jacksonville, FL 32203-0767 |
Second Address | Jacksonville, FL 32207-8566 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 17/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
065937100 | (05) | FL |
200016323 | RR MEDICARE (01) | FL |
D23787 | (02) | FL |