Healthcare Provider Details

I. General information

NPI: 1922081140
Provider Name (Legal Business Name): REBECCA LUCAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 827 BOX 78
APO AE
09617-0078
US

IV. Provider business mailing address

PSC 827 BOX 78
APO AE
09617-0078
US

V. Phone/Fax

Practice location:
  • Phone: 393357629468
  • Fax:
Mailing address:
  • Phone: 011393357629468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOP00001835
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: