Provider Demographics
NPI:1417905522
Name:LUCAS, DANIEL N (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:N
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:PO BOX 14687
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85267-4687
Mailing Address - Country:US
Mailing Address - Phone:480-991-8100
Mailing Address - Fax:480-992-1028
Practice Address - Street 1:11209 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3091
Practice Address - Country:US
Practice Address - Phone:602-248-8002
Practice Address - Fax:602-248-8399
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1395802085R0202X
AZ195602085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0324990OtherBCBS
AZ002189OtherAHCCCS
AZ1Z7049OtherHEALTHNET
AZAZ0324990OtherBCBS
AZWDBBFMedicare ID - Type Unspecified