MEDICARE: LUCID SLEEP DOCTORS, PLLC

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	207RP1001X	Pulmonary Disease Physician
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1134920911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUCID SLEEP DOCTORS, PLLC

Provider Business Mailing Address
First Line	:	2105 SIDNEY BAKER ST STE 200
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-2563
Country	:	US
Telephone Number	:	210-899-6730
Fax Number	:	833-776-0625

Provider Business Practice Location Address
First Line	:	2105 SIDNEY BAKER ST STE 200
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-2563
Country	:	US
Telephone Number	:	210-899-6730
Fax Number	:	833-776-0625

Authorized Official
Title or Position	:	ASSOCIATE
Name	:	TIFFINI CHERICE STRATTON
Credential	:	DDS
Telephone Number	:	210-269-3195

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	12/01/2025

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