MEDICARE: DR. DANIEL NATHAN LUCAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	19560	AZ
2	2085R0202X	Diagnostic Radiology Physician	ME139580	FL
3	2085R0202X	Diagnostic Radiology Physician	036131854	IL
4	2085R0202X	Diagnostic Radiology Physician	0101288870	VA
5	2085R0202X	Diagnostic Radiology Physician	MD158097	OR
6	2085R0202X	Diagnostic Radiology Physician	C1-0025605	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002189	OTHER	AZ	AHCCCS
2	AZ0324990	OTHER	AZ	BCBS
3	1Z7049	OTHER	AZ	HEALTHNET
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417905522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL NATHAN LUCAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 745249
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-5249
Country	:	US
Telephone Number	:	800-475-3698
Fax Number	:	706-653-1162

Provider Business Practice Location Address
First Line	:	11209 N TATUM BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85028-3091
Country	:	US
Telephone Number	:	602-248-8002
Fax Number	:	602-248-8399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	05/08/2026

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