Provider Demographics
NPI:1508291436
Name:LUCAS BINGHAM M.D., INC.
Entity Type:Organization
Organization Name:LUCAS BINGHAM M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:GARDNER
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-830-7222
Mailing Address - Street 1:600 CORPORATE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2107
Mailing Address - Country:US
Mailing Address - Phone:949-388-8022
Mailing Address - Fax:949-388-8033
Practice Address - Street 1:600 CORPORATE DR STE 100
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694
Practice Address - Country:US
Practice Address - Phone:949-388-8022
Practice Address - Fax:949-388-8033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104512207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty