Provider Demographics
NPI:1740247766
Name:LUCAS, NATHAN (DPM)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 KIRBY RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8221
Mailing Address - Country:US
Mailing Address - Phone:901-309-8898
Mailing Address - Fax:901-309-5908
Practice Address - Street 1:2900 KIRBY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8221
Practice Address - Country:US
Practice Address - Phone:901-309-8898
Practice Address - Fax:901-309-5908
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN481213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33525181OtherMEDICARE PTAN
TN4259570001OtherDMERC
TNU42202Medicare UPIN
TN4259570001OtherDMERC