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General NPI Number Information
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NPI Number | 1710259692
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Entity Type | Organization
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Legal Business Name | STEPHEN LUCERO, MD, PC
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 1650 HOSPITAL DR SUITE 300
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City | SANTA FE
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State | NM
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Zip | 87505-4769
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Country | US
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Telephone | 505-989-8325
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Fax | 505-982-7665
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Provider Business Mailing Address
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Address Line | 1650 HOSPITAL DR SUITE 300
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City | SANTA FE
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State | NM
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Zip | 87505-4769
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Country | US
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Telephone | 505-989-8325
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Fax | 505-982-7665
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN PAUL LUCERO
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Credential | MD
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Telephone | 505-989-8325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 86 273
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License Number State | NM
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