Healthcare Provider Details

I. General information

NPI: 1154414027
Provider Name (Legal Business Name): STEPHEN PAUL LUCERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HOSPITAL DR SUITE 300
SANTA FE NM
87505-4769
US

IV. Provider business mailing address

1650 HOSPITAL DR SUITE 300
SANTA FE NM
87505-4769
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-8325
  • Fax: 505-982-7665
Mailing address:
  • Phone: 505-989-8325
  • Fax: 505-982-7665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberNM 86 273
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: