Provider Demographics
NPI:1598751919
Name:LUCIO, DANIEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:LUCIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:175 HECTOR AVE
Mailing Address - Street 2:ATTN: HEIDI GWINN
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-2590
Mailing Address - Country:US
Mailing Address - Phone:504-349-6925
Mailing Address - Fax:504-362-5310
Practice Address - Street 1:175 HECTOR AVE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-2590
Practice Address - Country:US
Practice Address - Phone:504-349-6925
Practice Address - Fax:504-362-5310
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA10149R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1658286Medicaid
LA1658286Medicaid
LAG07804Medicare UPIN