Provider Demographics
NPI:1356301683
Name:HENDERSON, LUCAS (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:
Last Name:HENDERSON
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 1:9197 GRANT ST # 200
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4361
Mailing Address - Country:US
Mailing Address - Phone:303-450-3690
Mailing Address - Fax:303-450-3699
Practice Address - Street 1:9197 GRANT ST # 200
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4361
Practice Address - Country:US
Practice Address - Phone:303-450-3690
Practice Address - Fax:303-450-3699
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46289208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA222975OtherCONNECTICARE
MA30280OtherHEALTHNET
MAJ28328OtherBCBS
MA35676OtherHEALTH NEW ENGLAND