Healthcare Provider Details

I. General information

NPI: 1811052897
Provider Name (Legal Business Name): PETER B. LUCAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10191 NE BEACH CREST DR
BAINBRIDGE ISLAND WA
98110-1368
US

IV. Provider business mailing address

10191 NE BEACH CREST DR
BAINBRIDGE IS WA
98110-1368
US

V. Phone/Fax

Practice location:
  • Phone: 206-713-8713
  • Fax: 66-738-2612
Mailing address:
  • Phone: 206-713-8713
  • Fax: 206-673-8261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00031243
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG50158
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: