Provider Demographics
NPI:1659637767
Name:SMITH, LUCAS NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:NATHAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17712 LONG RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:321-258-7255
Mailing Address - Fax:
Practice Address - Street 1:1825 PARK PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1149
Practice Address - Country:US
Practice Address - Phone:321-258-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70590207R00000X
AL367082085R0202X
FLME1300312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine