Healthcare Provider Details

I. General information

NPI: 1518063726
Provider Name (Legal Business Name): JAMES L DE LUCAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 NEW YORK RD
PLATTSBURGH NY
12903-3981
US

IV. Provider business mailing address

PO BOX 978
PERU NY
12972-0978
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-2526
  • Fax: 518-563-2721
Mailing address:
  • Phone: 518-563-2526
  • Fax: 518-563-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number148702
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: