Provider Demographics
NPI:1629253240
Name:RICHARD W LUCEY MD PA
Entity Type:Organization
Organization Name:RICHARD W LUCEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-477-3453
Mailing Address - Street 1:710 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8803
Mailing Address - Country:US
Mailing Address - Phone:850-477-3453
Mailing Address - Fax:850-474-9420
Practice Address - Street 1:710 UNDERWOOD AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8803
Practice Address - Country:US
Practice Address - Phone:850-477-3453
Practice Address - Fax:850-474-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL97474Medicare PIN
FLD53185Medicare UPIN