Provider Demographics
NPI:1194780809
Name:LUCAS, ROBERT A (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:LUCAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3117 SPRING GLEN RD
Mailing Address - Street 2:STE 402
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5906
Mailing Address - Country:US
Mailing Address - Phone:904-224-2001
Mailing Address - Fax:904-224-2002
Practice Address - Street 1:6983-1 103RD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6800
Practice Address - Country:US
Practice Address - Phone:904-778-3000
Practice Address - Fax:904-771-2002
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1601213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55611Medicare UPIN
21698GMedicare PIN
87931WMedicare PIN
87931YMedicare PIN
87931XMedicare PIN
21698FMedicare PIN
21698EMedicare PIN