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General NPI Number Information
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NPI Number | 1518168806
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Entity Type | Individual
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Provider Name | LUCAS JEREMY BADER MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 12550 BISCAYNE BLVD STE 405
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City | NORTH MIAMI
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State | FL
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Zip | 33181-2539
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Country | US
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Telephone | 786-539-2421
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Fax | 786-619-3366
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone | 321-434-1401
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A112030
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | ME95823
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME95823
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License Number State | FL
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