Healthcare Provider Details

I. General information

NPI: 1073628400
Provider Name (Legal Business Name): JUDITH ALDRIDGE LUCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 POTRERO AVENUE BLDG 80 WARD 84
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

PO BOX 7464
SAN FRANCISCO CA
94120-7464
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-4082
  • Fax: 415-476-6953
Mailing address:
  • Phone: 415-476-4082
  • Fax: 415-476-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG46194
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberG46194
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG46194
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: