Provider Demographics
NPI:1932657194
Name:SIMONITCH, LUCAS RAY (PA-C)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:RAY
Last Name:SIMONITCH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 W MOONLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-7135
Mailing Address - Country:US
Mailing Address - Phone:214-535-0606
Mailing Address - Fax:
Practice Address - Street 1:10207 CHINA SPRING RD STE 170
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-7128
Practice Address - Country:US
Practice Address - Phone:254-788-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant