Healthcare Provider Details

I. General information

NPI: 1841238557
Provider Name (Legal Business Name): PETER M LUCORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 KALIKIMAKA PL
DIAMONDHEAD MS
39525-4176
US

IV. Provider business mailing address

952 KALIKIMAKA PL
DIAMONDHEAD MS
39525-4176
US

V. Phone/Fax

Practice location:
  • Phone: 228-586-1450
  • Fax:
Mailing address:
  • Phone: 228-586-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number021018
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: