MEDICARE: LUCAS BROWN

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	171100000X	Acupuncturist	AC01448	TX

General Provider Information

NPI Number	:	1043627649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCAS BROWN

Provider Business Mailing Address
First Line	:	1101 SHOAL CREEK BLVD APT 5
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2001
Country	:	US
Telephone Number	:	312-221-5258
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 BAYLOR ST
Second Line	:	STE 100
City	:	AUSTIN
State	:	TX
Zip	:	78703-4104
Country	:	US
Telephone Number	:	312-221-5258
Fax Number	:

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

Provider Enumeration Date	:	07/15/2014
Last Update Date	:	07/15/2014

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Directions to “ LUCAS BROWN ” Practice Location

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