Provider Demographics
NPI:1295297430
Name:LUCCOCK, DANIEL J (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:LUCCOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-382-1205
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:3190 N SWAN RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1227
Practice Address - Country:US
Practice Address - Phone:520-547-9700
Practice Address - Fax:520-547-9719
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2022-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZR77285207Q00000X
AZ65915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty