Provider Demographics
NPI:1356311864
Name:LUCAS, CHRISTOPHER CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:LUCAS
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:USS CARL VINSON
Mailing Address - Street 2:CVN 70
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09566-2840
Mailing Address - Country:US
Mailing Address - Phone:757-534-0703
Mailing Address - Fax:
Practice Address - Street 1:USS CARL VINSON
Practice Address - Street 2:CVN 70
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09566-2840
Practice Address - Country:US
Practice Address - Phone:757-534-0703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 72359207Q00000X, 2083A0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD0000Medicare UPIN