Provider Demographics
NPI:1295700987
Name:BINGHAM, LUCAS G (MD)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:G
Last Name:BINGHAM
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 1:600 CORPORATE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2106
Mailing Address - Country:US
Mailing Address - Phone:949-388-8022
Mailing Address - Fax:949-388-8033
Practice Address - Street 1:600 CORPORATE DR
Practice Address - Street 2:STE 100
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2106
Practice Address - Country:US
Practice Address - Phone:949-388-8022
Practice Address - Fax:949-388-8033
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47852207N00000X
AZ36857207N00000X
CAA104512207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860800150 85259 B201OtherTRICARE
AZ265506Medicaid
AZP00425647OtherRAILROAD MEDICARE
MN783850600Medicaid
MN783850600Medicaid
CABG556GMedicare PIN
CABG556HMedicare PIN
CAAU885XMedicare PIN
CABG556EMedicare PIN
AZP00425647OtherRAILROAD MEDICARE
AZ860800150 85259 B201OtherTRICARE
I42188Medicare UPIN
AZ265506Medicaid
CABG556DMedicare PIN
MN070000715Medicare PIN
CABG556BMedicare PIN
CAAU885YMedicare PIN
AZZ118068Medicare PIN
CAAU885WMedicare PIN
CAAU885VMedicare PIN
CABG556AMedicare PIN
CABG556IMedicare PIN
CAAU885ZMedicare PIN