Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 4301058724 | MI |
Y | 2086S0120X | Pediatric Surgery | 9972 | MT |
NPI | 1437129046 |
---|---|
Provider Name | Scott William Lucas |
First Address | Great Falls, MT 59405 |
Second Address | Great Falls, MT 59405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0146978 | (05) | MT |
G60391 | (02) |