Provider Demographics
NPI:1699270991
Name:BRACERO, LUCAS ALFONSO (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:ALFONSO
Last Name:BRACERO
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1652
Mailing Address - Country:US
Mailing Address - Phone:304-347-6120
Mailing Address - Fax:304-347-6126
Practice Address - Street 1:400 COURT ST STE 100
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1652
Practice Address - Country:US
Practice Address - Phone:304-347-6120
Practice Address - Fax:304-347-6120
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32685208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine