Healthcare Provider Details

I. General information

NPI: 1073865754
Provider Name (Legal Business Name): JAMES DAVID LUCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 E FLETCHER AVE STE 240
TAMPA FL
33613-4600
US

IV. Provider business mailing address

3155 LAKESTONE DR
TAMPA FL
33618-1120
US

V. Phone/Fax

Practice location:
  • Phone: 813-558-1477
  • Fax:
Mailing address:
  • Phone: 239-777-8576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: