Healthcare Provider Details

I. General information

NPI: 1336131069
Provider Name (Legal Business Name): DAVID H LUCAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OAKLEY SEAVER DR
CLERMONT FL
34711
US

IV. Provider business mailing address

2020 OAKLEY SEAVER DR
CLERMONT FL
34711
US

V. Phone/Fax

Practice location:
  • Phone: 352-242-0404
  • Fax: 352-242-5278
Mailing address:
  • Phone: 352-242-0404
  • Fax: 352-242-5278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberME0057701
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: