Provider Demographics
NPI:1407843485
Name:LUCAS, SCOTT K (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:K
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 1:608 NW 9TH ST
Mailing Address - Street 2:STE 2110
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1030
Mailing Address - Country:US
Mailing Address - Phone:405-310-3028
Mailing Address - Fax:405-801-2344
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:SUITE 2110
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1030
Practice Address - Country:US
Practice Address - Phone:405-310-3028
Practice Address - Fax:405-801-2344
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11551208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKD34965Medicare UPIN