Provider Demographics
NPI:1235766973
Name:LUCAS, LOGAN EUGENE (DO)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:EUGENE
Last Name:LUCAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 LEFT PENHOOK RD
Mailing Address - Street 2:
Mailing Address - City:HAROLD
Mailing Address - State:KY
Mailing Address - Zip Code:41635-7064
Mailing Address - Country:US
Mailing Address - Phone:606-285-6690
Mailing Address - Fax:
Practice Address - Street 1:24 LEFT PENHOOK RD
Practice Address - Street 2:
Practice Address - City:HAROLD
Practice Address - State:KY
Practice Address - Zip Code:41635-7064
Practice Address - Country:US
Practice Address - Phone:606-285-6690
Practice Address - Fax:606-478-4801
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine