Provider Demographics
NPI:1174632715
Name:LUCAS, WALTER WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:WAYNE
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5270 BUDAPEST PL
Mailing Address - Street 2:HEALTH UNIT
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20189-5270
Mailing Address - Country:US
Mailing Address - Phone:361-475-4092
Mailing Address - Fax:361-311-1802
Practice Address - Street 1:5270 BUDAPEST PL
Practice Address - Street 2:HEALTH UNIT
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20189-5270
Practice Address - Country:US
Practice Address - Phone:361-475-4092
Practice Address - Fax:361-311-1802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00018340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine