Provider Demographics
NPI:1184204554
Name:WALK, LUCAS ALEXANDER (DO)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:ALEXANDER
Last Name:WALK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-4846
Mailing Address - Country:US
Mailing Address - Phone:435-659-5518
Mailing Address - Fax:
Practice Address - Street 1:8901 E RAINTREE DR STE 150
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7110
Practice Address - Country:US
Practice Address - Phone:480-733-7600
Practice Address - Fax:602-805-2816
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ011057207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine