Provider Demographics
NPI:1790912244
Name:FERRER CARDONA, LUCAS MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:MANUEL
Last Name:FERRER CARDONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUCAS
Other - Middle Name:M
Other - Last Name:FERRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4502 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4402
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:210-450-4903
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-2074
Practice Address - Fax:210-358-4779
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR8560208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388930502OtherCSHCN
TX388930501Medicaid