Healthcare Provider Details

I. General information

NPI: 1417905522
Provider Name (Legal Business Name): DANIEL NATHAN LUCAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11209 N TATUM BLVD
PHOENIX AZ
85028-3091
US

IV. Provider business mailing address

PO BOX 745249
LOS ANGELES CA
90074-5249
US

V. Phone/Fax

Practice location:
  • Phone: 602-248-8002
  • Fax: 602-248-8399
Mailing address:
  • Phone: 800-475-3698
  • Fax: 706-653-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number19560
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME139580
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036131854
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101288870
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD158097
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC1-0025605
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: