Provider Demographics
NPI:1548647795
Name:LUCAS, STEPHANIE KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KATHERINE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1925 E ORMAN AVE STE A535
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3559
Mailing Address - Country:US
Mailing Address - Phone:719-564-0450
Mailing Address - Fax:719-564-1659
Practice Address - Street 1:1925 E ORMAN AVE STE A535
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004
Practice Address - Country:US
Practice Address - Phone:719-564-0450
Practice Address - Fax:719-564-1659
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0058648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine