MEDICARE: LUCAS MCINTYRE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	MD60682919	WA

General Provider Information

NPI Number	:	1043624240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS MCINTYRE MD

Provider Business Mailing Address
First Line	:	316 S I ST FL 1
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4212
Country	:	US
Telephone Number	:	253-403-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 S I ST FL 1
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4212
Country	:	US
Telephone Number	:	253-403-0556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/02/2020

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