Provider Demographics
NPI:1285648659
Name:ANDREWS, LUCIUS CLAYTON JR (MD)
Entity Type:Individual
Prefix:
First Name:LUCIUS
Middle Name:CLAYTON
Last Name:ANDREWS
Suffix:JR
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 1:3025 OCTAVIA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70125-4933
Mailing Address - Country:US
Mailing Address - Phone:504-866-4281
Mailing Address - Fax:504-366-1029
Practice Address - Street 1:149 DRINK WATER BLVD
Practice Address - Street 2:HANCOCK MEDICAL CENTER
Practice Address - City:BAY SAINT LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520
Practice Address - Country:US
Practice Address - Phone:228-467-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15191207P00000X
LA15623207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118026Medicaid
B65238Medicare UPIN