Provider Demographics
NPI:1669796793
Name:A DANIEL LUCIUS JR MD PA
Entity type:Organization
Organization Name:A DANIEL LUCIUS JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:LUCIUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:281-420-5760
Mailing Address - Street 1:4301 GARTH RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3159
Mailing Address - Country:US
Mailing Address - Phone:281-420-5760
Mailing Address - Fax:281-427-8977
Practice Address - Street 1:4301 GARTH RD
Practice Address - Street 2:SUITE 311
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3159
Practice Address - Country:US
Practice Address - Phone:281-420-5760
Practice Address - Fax:281-427-8977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD2263207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097718301Medicaid
00C842Medicare PIN
D66851Medicare UPIN