Provider Demographics
NPI:1538304605
Name:MYERS, LUCINDA TRIPPE (M D)
Entity type:Individual
Prefix:DR
First Name:LUCINDA
Middle Name:TRIPPE
Last Name:MYERS
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HERRING AVE
Mailing Address - Street 2:(PO BOX 5100)
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-3239
Mailing Address - Country:US
Mailing Address - Phone:254-202-8494
Mailing Address - Fax:254-202-8649
Practice Address - Street 1:3000 HERRING AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-3239
Practice Address - Country:US
Practice Address - Phone:254-202-8155
Practice Address - Fax:254-202-3399
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-15416208100000X
TXQ1238208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1538304605Medicaid