Healthcare Provider Details

I. General information

NPI: 1790131787
Provider Name (Legal Business Name): LINDSAY T LUCAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 LPGA BLVD
DAYTONA BEACH FL
32117-7108
US

IV. Provider business mailing address

1865 LPGA BLVD
DAYTONA BEACH FL
32117-7108
US

V. Phone/Fax

Practice location:
  • Phone: 386-255-4596
  • Fax: 386-254-6819
Mailing address:
  • Phone: 386-255-4596
  • Fax: 386-254-6819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number88948
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberME157811
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL39325
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME157811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: