Provider Demographics
NPI:1356330518
Name:LUCAS, CHARLES S (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
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 1:1555 HOWELL BRANCH RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1109
Mailing Address - Country:US
Mailing Address - Phone:407-644-6465
Mailing Address - Fax:407-647-4251
Practice Address - Street 1:1555 HOWELL BRANCH RD
Practice Address - Street 2:SUITE B2
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1109
Practice Address - Country:US
Practice Address - Phone:407-644-6465
Practice Address - Fax:407-647-4251
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME14577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55441Medicare UPIN
FL48769ZMedicare ID - Type Unspecified