Provider Demographics
NPI:1285742783
Name:EVANS, LUCAS JAY (MPH PA-C)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:JAY
Last Name:EVANS
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Gender:M
Credentials:MPH PA-C
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Mailing Address - Street 1:4800 LINTON BLVD
Mailing Address - Street 2:BUILDING A SUITE 201
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445
Mailing Address - Country:US
Mailing Address - Phone:561-496-6622
Mailing Address - Fax:561-496-6577
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:BUILDING A SUITE 201
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445
Practice Address - Country:US
Practice Address - Phone:561-496-6622
Practice Address - Fax:561-496-6577
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102141207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP80249Medicare UPIN
FLU0117Medicare ID - Type Unspecified