Provider Demographics
NPI:1376633552
Name:LUCAS, RODNEY DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:DANIEL
Last Name:LUCAS
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 1:6550 SHORELINE DR
Mailing Address - Street 2:# 7403
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-4588
Mailing Address - Country:US
Mailing Address - Phone:703-362-0288
Mailing Address - Fax:
Practice Address - Street 1:6550 SHORELINE DR
Practice Address - Street 2:# 7403
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-4588
Practice Address - Country:US
Practice Address - Phone:703-362-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012282042085R0202X
CAG733852085R0202X
WI36212-0202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology