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General NPI Number Information
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NPI Number | 1912189697
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Entity Type | Organization
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Legal Business Name | ERNEST A. LUCERO, MD PC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 6641 KANIKSU ST STE B
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City | BONNERS FERRY
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State | ID
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Zip | 83805-7532
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Country | US
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Telephone | 208-267-2086
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Fax | 208-267-4013
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Provider Business Mailing Address
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Address Line | 6641 KANIKSU ST STE B PO BOX 898
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City | BONNERS FERRY
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State | ID
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Zip | 83805-7532
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Country | US
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Telephone | 208-267-2086
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Fax | 208-267-4013
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERNEST ANTHONY LUCERO
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Credential | M.D.
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Telephone | 208-267-2086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | M5577
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License Number State | ID
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