Provider Demographics
NPI:1811052897
Name:LUCAS, PETER B (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:LUCAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10191 NE BEACH CREST DR
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE IS
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1368
Mailing Address - Country:US
Mailing Address - Phone:206-713-8713
Mailing Address - Fax:206-673-8261
Practice Address - Street 1:10191 NE BEACH CREST DR
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1368
Practice Address - Country:US
Practice Address - Phone:206-713-8713
Practice Address - Fax:066-738-2612
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000312432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8196461Medicaid
WA00031243OtherMEDICAL LICENSE
CAG50158OtherMEDICAL LICENSE
WA8196461Medicaid
WAG8872442Medicare PIN