Provider Demographics
NPI:1033354386
Name:LUCAS, MADISON JEROME I
Entity Type:Individual
Prefix:DR
First Name:MADISON
Middle Name:JEROME
Last Name:LUCAS
Suffix:I
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:LUCAS
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5991 CRESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2219
Mailing Address - Country:US
Mailing Address - Phone:303-986-8700
Mailing Address - Fax:
Practice Address - Street 1:5991 CRESTBROOK DR
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2219
Practice Address - Country:US
Practice Address - Phone:303-986-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15687207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine