Provider Demographics
NPI:1952707838
Name:LUCAS, REGGINOLD PRESCOTT
Entity Type:Individual
Prefix:MR
First Name:REGGINOLD
Middle Name:PRESCOTT
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EVEREST CIRCLE
Mailing Address - Street 2:APT 4
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:417-294-6032
Mailing Address - Fax:
Practice Address - Street 1:220 EVEREST CIRCLE
Practice Address - Street 2:APT 4
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-294-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider