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NPI Code Detail

MEDICARE: DR. CHARLES S LUCAS M.D.

MEDICARE: DR. CHARLES S LUCAS M.D.
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
1174400000XSpecialistME14577FL

General Provider Information

NPI Number : 1356330518
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES S LUCAS M.D.
Provider Business Mailing Address
First Line : 1555 HOWELL BRANCH RD
Second Line : SUITE B2
City : WINTER PARK
State : FL
Zip : 32789-1109
Country : US
Telephone Number : 407-644-6465
Fax Number : 407-647-4251
Provider Business Practice Location Address
First Line : 1555 HOWELL BRANCH RD
Second Line : SUITE B2
City : WINTER PARK
State : FL
Zip : 32789-1109
Country : US
Telephone Number : 407-644-6465
Fax Number : 407-647-4251
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 07/08/2007

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