Provider Demographics
NPI:1780623942
Name:LUCAS, JULIE ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ROSE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ROSE
Other - Last Name:EDMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-660-5787
Mailing Address - Fax:251-660-5740
Practice Address - Street 1:75 S UNIVERSITY BLVD
Practice Address - Street 2:UCOM 6000 A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0002
Practice Address - Country:US
Practice Address - Phone:251-660-5787
Practice Address - Fax:251-660-5540
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009930270Medicaid
MS0124863Medicaid
AL51098015OtherBCBS
AL51098018OtherBCBS
AL009930270Medicaid
AL000009801Medicare ID - Type Unspecified
AL970019024Medicare ID - Type UnspecifiedRAILROAD PGBA