Provider Demographics
NPI:1962401968
Name:LOUCKS, DONALD LAMAR (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:LAMAR
Last Name:LOUCKS
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 1:1300 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4646
Mailing Address - Country:US
Mailing Address - Phone:850-216-0100
Mailing Address - Fax:
Practice Address - Street 1:1300 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4646
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000OtherBEECHST/CAPP CARE
FL00000OtherEVOLUTIONS
FL000000OtherUNIVERSAL HEALTH CARE
FL057262400Medicaid
FL37222OtherBCBSFL
GA00134945AMedicaid
FL00000OtherNOVANET
FL00000OtherUNITEDHEALTH CARE
FL00000OtherCAPITAL HEALTH PLAN
FL00000OtherSOUTHCARE
FL000000OtherUNIVERSAL HEALTH CARE