Healthcare Provider Details

I. General information

NPI: 1366860124
Provider Name (Legal Business Name): ALAN PAUL LUCAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 SE STRATUS AVE
MCMINNVILLE OR
97128-6255
US

IV. Provider business mailing address

2700 SE STRATUS AVE
MCMINNVILLE OR
97128-6255
US

V. Phone/Fax

Practice location:
  • Phone: 503-435-6441
  • Fax: 503-435-6445
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD188951
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD188951
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: