Healthcare Provider Details

I. General information

NPI: 1982661492
Provider Name (Legal Business Name): SILAS EMMETT LUCAS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 INTERNATIONAL DR
GREENVILLE SC
29615-4816
US

IV. Provider business mailing address

35 INTERNATIONAL DR
GREENVILLE SC
29615-4816
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-7654
  • Fax: 864-675-1657
Mailing address:
  • Phone: 864-234-7654
  • Fax: 864-675-1657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number18085
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number18085
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: