Provider Demographics
NPI:1952393019
Name:LUCE, PATRICIA H (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:H
Last Name:LUCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 S LOOP 256
Mailing Address - Street 2:SUITE S
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8491
Mailing Address - Country:US
Mailing Address - Phone:903-729-2428
Mailing Address - Fax:903-723-2892
Practice Address - Street 1:4002 S LOOP 256
Practice Address - Street 2:SUITE S
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8491
Practice Address - Country:US
Practice Address - Phone:903-729-2428
Practice Address - Fax:903-723-2892
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8036208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130491708Medicaid
TX130491708Medicaid