Provider Demographics
NPI:1265424469
Name:LUCID, HENRY S (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:S
Last Name:LUCID
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 1:16010 PARK VALLEY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3574
Mailing Address - Country:US
Mailing Address - Phone:512-206-2999
Mailing Address - Fax:
Practice Address - Street 1:16010 PARK VALLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3574
Practice Address - Country:US
Practice Address - Phone:512-206-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2357207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
7531163OtherAETNA/TRS
TX1870239OtherFIRST HEALTH
TX8B9681OtherBC/BS
966648OtherGREAT WEST
78681-B002OtherCHAMPS/TRICARE
966648OtherGREAT WEST
7531163OtherAETNA/TRS
TX8493KZMedicare ID - Type Unspecified