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General NPI Number Information
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NPI Number | 1508291436
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Entity Type | Organization
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Legal Business Name | LUCAS BINGHAM M.D., INC.
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 600 CORPORATE DR STE 100
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City | LADERA RANCH
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State | CA
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Zip | 92694
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Country | US
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Telephone | 949-388-8022
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Fax | 949-388-8033
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Provider Business Mailing Address
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Address Line | 600 CORPORATE DR STE 100
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City | LADERA RANCH
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State | CA
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Zip | 92694-2107
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Country | US
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Telephone | 949-388-8022
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Fax | 949-388-8033
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | LUCAS GARDNER BINGHAM
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Credential | M.D.
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Telephone | 801-830-7222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A104512
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License Number State | CA
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