Healthcare Provider Details

I. General information

NPI: 1497376263
Provider Name (Legal Business Name): LUCAS EDWARD PLACE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 NW 9TH BLVD
GAINESVILLE FL
32605-4251
US

IV. Provider business mailing address

6900 NW 9TH BLVD
GAINESVILLE FL
32605-4251
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-6680
  • Fax:
Mailing address:
  • Phone: 352-333-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS20403
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: