MEDICARE: JASON LUCAS DO

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	207XX0801X	Orthopaedic Trauma Physician	A127504	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00NM009P18	OTHER	NM	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	A-1275-04	OTHER	NM	NM MEDICAL LIS

General Provider Information

NPI Number	:	1598749061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON LUCAS DO

Provider Business Mailing Address
First Line	:	2300 E 30TH ST BLDG D
Second Line	:	STE 101
City	:	FARMINGTON
State	:	NM
Zip	:	87401-8990
Country	:	US
Telephone Number	:	505-326-1400
Fax Number	:	505-327-3474

Provider Business Practice Location Address
First Line	:	2300 E 30TH ST BLDG D
Second Line	:	STE 101
City	:	FARMINGTON
State	:	NM
Zip	:	87401-8990
Country	:	US
Telephone Number	:	505-326-1400
Fax Number	:	505-327-3474

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	05/06/2008

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Directions to “ JASON LUCAS DO” Practice Location

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