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General NPI Number Information
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NPI Number | 1205185808
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Entity Type | Organization
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Legal Business Name | THE LUCAS CENTER, PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 10810 PARKSIDE DR SUITE 310
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City | KNOXVILLE
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State | TN
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Zip | 37934
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Country | US
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Telephone | 865-218-6210
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Fax | 865-218-6211
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Provider Business Mailing Address
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Address Line | 10810 PARKSIDE DR SUITE 310
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City | KNOXVILLE
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State | TN
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Zip | 37934
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Country | US
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Telephone | 865-218-6210
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Fax | 865-218-6211
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Authorized Official
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Title or Position | CHIEF OFFICER/OWNER/PHYSICIAN
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Name | DR. JAY H LUCAS
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Credential | M.D.
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Telephone | 865-218-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD0000036890
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License Number State | TN
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