Provider Demographics
NPI:1821081902
Name:LUCAS, RENE ANGEL (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:ANGEL
Last Name:LUCAS
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 1:18444 N 25TH AVE
Mailing Address - Street 2:STE 310
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-1266
Mailing Address - Country:US
Mailing Address - Phone:623-537-5600
Mailing Address - Fax:866-939-2673
Practice Address - Street 1:10494 W THUNDERBIRD RD
Practice Address - Street 2:STE102
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-6122
Practice Address - Country:US
Practice Address - Phone:623-537-5600
Practice Address - Fax:866-939-2673
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19775208100000X, 208VP0000X, 208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5550830001OtherMEDICARE NSC SCW
AZ5550830006OtherMEDICARE NSC ANTHEM
AZP00363400OtherRR MEDICARE
AZ5550830004OtherMEDICARE NSC PV
AZ5550830009OtherMEDICARE NSC AZ NORTH
AZ5550830010OtherMEDICARE NSC GILBERT
AZ013061Medicaid
AZ5550830007OtherMEDICARE NSC DV
AZ5550830003OtherMEDICARE NSC PEORIA
AZ5550830008OtherMEDICARE NSC SWV
AZ5550830004OtherMEDICARE NSC PV
AZ5550830009OtherMEDICARE NSC AZ NORTH