Provider Demographics
NPI:1144285602
Name:LUCERO, JOSEPH W (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:LUCERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:TRI-STATE ANESTHESIA GROUP PSC
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25708-0390
Mailing Address - Country:US
Mailing Address - Phone:304-208-6411
Mailing Address - Fax:304-429-3109
Practice Address - Street 1:2001 SCIOTO TRL
Practice Address - Street 2:KING'S DAUGHTERS MEDICAL CENTER OHIO
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2845
Practice Address - Country:US
Practice Address - Phone:740-991-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005021464207L00000X
CAG64221207L00000X
OH35.124078207L00000X
VA0101047756207L00000X
IDM7130207L00000X
NE23203207L00000X
WY7836A207L00000X
PAMD438898207L00000X
ND13268207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207286006Medicaid
MO207286006Medicaid