Provider Demographics
NPI:1962027045
Name:PETER LUCAS, PLLC
Entity Type:Organization
Organization Name:PETER LUCAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-713-8713
Mailing Address - Street 1:10191 NE BEACH CREST DR
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1368
Mailing Address - Country:US
Mailing Address - Phone:206-713-8713
Mailing Address - Fax:
Practice Address - Street 1:10191 NE BEACH CREST DR
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1368
Practice Address - Country:US
Practice Address - Phone:206-713-8713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00031243OtherMEDICAL LICENSE
CAG50158OtherSTATE LICENSE