Provider Demographics
NPI:1073557260
Name:LUND, LUCAS ZEBEDIAH (DO)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:ZEBEDIAH
Last Name:LUND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:603-204-5251
Practice Address - Street 1:5765 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2013
Practice Address - Country:US
Practice Address - Phone:916-887-7955
Practice Address - Fax:916-739-3617
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-11-20
Deactivation Date:2020-07-14
Deactivation Code:
Reactivation Date:2022-11-15
Provider Licenses
StateLicense IDTaxonomies
VT032.0000428207Q00000X
CA20A23047207QH0002X
NH125012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30223178Medicaid
NHRE7969Medicare PIN
NHI10386Medicare UPIN