Provider Demographics
NPI:1821095530
Name:CLOVER, LUCIA L (MD)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:L
Last Name:CLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:13184 N 103RD DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3038
Practice Address - Country:US
Practice Address - Phone:623-972-2902
Practice Address - Fax:623-972-2539
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ156315OtherUNIVERSAL HEALTHCARE
AZ3Z0577OtherHEALTH NET
AZP01730129OtherRR MEDICARE
AZ0000354366OtherMERCY CARE PLAN
AZ3Z3840OtherHEALTH NET
AZ5352333OtherAETNA
AZ3671278OtherCIGNA
AZ354366Medicaid
AZ24233OtherLICENSE
AZ30WCHGBQ08Medicare PIN
AZ156315OtherUNIVERSAL HEALTHCARE
AZ5352333OtherAETNA
AZG30795Medicare UPIN
AZZ194541Medicare PIN