MEDICARE: DR. NATHAN LUCAS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	481	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33525181	OTHER	TN	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4259570001	OTHER	TN	DMERC

General Provider Information

NPI Number	:	1740247766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN LUCAS DPM

Provider Business Mailing Address
First Line	:	2900 KIRBY RD
Second Line	:	SUITE 5
City	:	MEMPHIS
State	:	TN
Zip	:	38119-8221
Country	:	US
Telephone Number	:	901-309-8898
Fax Number	:	901-309-5908

Provider Business Practice Location Address
First Line	:	2900 KIRBY RD
Second Line	:	SUITE 5
City	:	MEMPHIS
State	:	TN
Zip	:	38119-8221
Country	:	US
Telephone Number	:	901-309-8898
Fax Number	:	901-309-5908

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	04/09/2020

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Directions to “ DR. NATHAN LUCAS DPM” Practice Location

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