Provider Demographics
NPI:1235193459
Name:LUCAS, GERALD L (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1760 E RIVER RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5877
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7910
Practice Address - Street 1:2222 E HIGHLAND AVE
Practice Address - Street 2:SUITE # 130
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4872
Practice Address - Country:US
Practice Address - Phone:602-283-2345
Practice Address - Fax:602-283-3039
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2018-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ210112085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ116477OtherAHCCCS
AZ86-0938204OtherTAX ID
AZ86-0938204OtherTAX ID
AZZ124999Medicare PIN
AZF00255Medicare UPIN