MEDICARE: DR. LUCAS S CANTON 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	208000000X	Pediatrics Physician	31765	AZ

General Provider Information

NPI Number	:	1952306821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCAS S CANTON M.D.

Provider Business Mailing Address
First Line	:	4615 S CENTRAL AVE
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2148
Country	:	US
Telephone Number	:	602-232-2737
Fax Number	:	602-232-2736

Provider Business Practice Location Address
First Line	:	4615 S CENTRAL AVE
Second Line	:	SUITE A
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2148
Country	:	US
Telephone Number	:	602-232-2737
Fax Number	:	602-232-2736

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/18/2012

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