Provider Demographics
NPI:1659509248
Name:LUCIA, MARK WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:LUCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1004 S ROCK ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5837
Mailing Address - Country:US
Mailing Address - Phone:512-279-0348
Mailing Address - Fax:512-371-8788
Practice Address - Street 1:5656 BEE CAVES RD
Practice Address - Street 2:SUITE M-302
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5280
Practice Address - Country:US
Practice Address - Phone:512-697-3502
Practice Address - Fax:512-371-8788
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP6673207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology