Provider Demographics
NPI:1992708077
Name:LUCAS, DOLORES J (MD)
Entity type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:J
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2850
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:127 CRESTVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2850
Practice Address - Country:US
Practice Address - Phone:615-446-5121
Practice Address - Fax:615-446-1357
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD30869207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070015085OtherRAILROAD MEDICARE PIN
TN3158200OtherBLUE CROSS BLUE SHIELD TN
TN3851191Medicaid
G85736Medicare UPIN
TN3158200OtherBLUE CROSS BLUE SHIELD TN