Provider Demographics
NPI:1619955341
Name:LUCAS, PATRICIA MARION (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARION
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:MARION
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:359 MEDICAL GROUP
Mailing Address - Street 2:221 3RD ST WEST BLDG 1040
Mailing Address - City:JBSA-RANOLPH
Mailing Address - State:TX
Mailing Address - Zip Code:78150-4267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:359 MEDICAL GROUP
Practice Address - Street 2:221 THIRD STREET WEST BLDG 1040
Practice Address - City:JOINT BASE SAN ANTONIO-RANDOLPH
Practice Address - State:TX
Practice Address - Zip Code:78150
Practice Address - Country:US
Practice Address - Phone:210-652-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1046215363AM0700X
TXPA06993363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1046215OtherNCCPA
TXPA06993OtherSTATE LICENSE