Healthcare Provider Details

I. General information

NPI: 1235193459
Provider Name (Legal Business Name): GERALD L LUCAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE SUITE # 130
PHOENIX AZ
85016-4872
US

IV. Provider business mailing address

1760 E RIVER RD SUITE 350
TUCSON AZ
85718-5877
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-2345
  • Fax: 602-283-3039
Mailing address:
  • Phone: 520-519-7775
  • Fax: 520-519-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number21011
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: