MEDICARE: DR. JOSEPH W LUCERO 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	207L00000X	Anesthesiology Physician	2005021464	MO
2	207L00000X	Anesthesiology Physician	G64221	CA
3	207L00000X	Anesthesiology Physician	35.124078	OH
4	207L00000X	Anesthesiology Physician	0101047756	VA
5	207L00000X	Anesthesiology Physician	M7130	ID
6	207L00000X	Anesthesiology Physician	23203	NE
7	207L00000X	Anesthesiology Physician	7836A	WY
8	207L00000X	Anesthesiology Physician	MD438898	PA
9	207L00000X	Anesthesiology Physician	13268	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144285602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH W LUCERO MD

Provider Business Mailing Address
First Line	:	PO BOX 390
Second Line	:	TRI-STATE ANESTHESIA GROUP PSC
City	:	HUNTINGTON
State	:	WV
Zip	:	25708-0390
Country	:	US
Telephone Number	:	304-208-6411
Fax Number	:	304-429-3109

Provider Business Practice Location Address
First Line	:	2001 SCIOTO TRL
Second Line	:	KING'S DAUGHTERS MEDICAL CENTER OHIO
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-2845
Country	:	US
Telephone Number	:	740-991-4000
Fax Number	:

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	03/25/2015

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Directions to “ DR. JOSEPH W LUCERO MD” Practice Location

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