Provider Demographics
NPI:1316949159
Name:LUCAS, SHAUNA L (MD)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:L
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
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 21850
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1850
Mailing Address - Country:US
Mailing Address - Phone:501-609-2222
Mailing Address - Fax:501-321-9689
Practice Address - Street 1:1 MERCY LN
Practice Address - Street 2:SUITE 201
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6442
Practice Address - Country:US
Practice Address - Phone:501-609-2222
Practice Address - Fax:501-321-9689
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1646208M00000X
ARE1646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR136517001Medicaid
G82920Medicare UPIN
G82920Medicare UPIN