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General NPI Number Information
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NPI Number | 1770637209
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Entity Type | Individual
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Provider Name | EUGENE JOSEPH LUCERO PAC
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 308 MAIN ST.
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City | OLATHE
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State | CO
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Zip | 81425
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Country | US
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Telephone | 970-323-6141
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Fax | 970-323-6117
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Provider Business Mailing Address
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Address Line | PO BOX 529
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City | OLATHE
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State | CO
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Zip | 81425-0529
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Country | US
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Telephone | 970-323-6141
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Fax | 970-323-6117
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1068231
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License Number State |
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