Healthcare Provider Details

I. General information

NPI: 1174198683
Provider Name (Legal Business Name): LUCAS ERNANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date: 02/21/2023
Reactivation Date: 07/23/2024

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100118
GAINESVILLE FL
32610-0118
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0535
  • Fax: 352-627-4173
Mailing address:
  • Phone: 352-265-0535
  • Fax: 352-627-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME171186
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberME171186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: