Provider Demographics
NPI:1316932957
Name:LUCIO, JOHN C (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:LUCIO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2505 MISSION DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-9508
Mailing Address - Country:US
Mailing Address - Phone:573-681-3759
Mailing Address - Fax:573-681-3659
Practice Address - Street 1:2505 MISSION DR
Practice Address - Street 2:SUITE 200
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-9508
Practice Address - Country:US
Practice Address - Phone:573-681-3759
Practice Address - Fax:573-681-3659
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2020-12-15
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Provider Licenses
StateLicense IDTaxonomies
MO109799207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO050050621OtherRR MEDICARE
MO248216806Medicaid
MO008011074Medicare ID - Type Unspecified
MO248216806Medicaid
MOG23104Medicare UPIN