MEDICARE: JAY L LUCAS,MD PC

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	174400000X	Specialist	9934	SC

General Provider Information

NPI Number	:	1063770931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY L LUCAS,MD PC

Provider Business Mailing Address
First Line	:	1540 AMERICAN DR
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505-6072
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 AMERICAN DR
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29505-6072
Country	:	US
Telephone Number	:	843-317-9999
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAY LUCAS
Credential	:
Telephone Number	:	843-317-9999

Provider Enumeration Date	:	04/30/2012
Last Update Date	:	01/22/2020

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