Provider Demographics
NPI:1598297889
Name:LUCAS, GARY JOSHUA
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:JOSHUA
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 BROADWAY
Mailing Address - Street 2:SMC GENERAL SURGERY RESIDENCY PROGRAM
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4307
Mailing Address - Country:US
Mailing Address - Phone:206-386-2123
Mailing Address - Fax:206-860-6540
Practice Address - Street 1:747 BROADWAY
Practice Address - Street 2:SMC GENERAL SURGERY RESIDENCY PROGRAM
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4307
Practice Address - Country:US
Practice Address - Phone:206-386-2123
Practice Address - Fax:206-860-6540
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program