Provider Demographics
NPI:1164548004
Name:LUCEY, RICHARD W (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:LUCEY
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 1:710 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8803
Mailing Address - Country:US
Mailing Address - Phone:850-477-3453
Mailing Address - Fax:850-474-9420
Practice Address - Street 1:710 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8803
Practice Address - Country:US
Practice Address - Phone:850-477-3453
Practice Address - Fax:850-474-9420
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17213OtherBCBS FL
FLD53185Medicare UPIN