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General NPI Number Information
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NPI Number | 1659476216
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Entity Type | Individual
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Provider Name | DOUGLAS J LUCAS NP
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 6309 E BAYWOOD AVE
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City | MESA
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State | AZ
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Zip | 85206-1744
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Country | US
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Telephone | 480-325-3801
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Fax | 480-325-3805
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Provider Business Mailing Address
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Address Line | PO BOX 13550
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City | MESA
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State | AZ
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Zip | 85216-3550
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Country | US
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Telephone | 480-325-3801
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Fax | 480-325-3805
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN101467
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License Number State | AZ
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