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Organization
PHYSICIAN ASSISTS INC
Active
Organization
PHYSICIAN ASSISTS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LUCERO PAC (OWNER)
(772) 235-0850
Entity
Organization
Contact information
Practice address
1000 36TH ST, VERO BEACH, FL 32960-4862
(772) 567-4311
Mailing address
PO BOX 644102, VERO BEACH, FL 32964-4102
(772) 235-0850
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9102527
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD8239
RR MEDICARE
FL
01
—
X1617
BLUE CROSS
FL
Enumeration date
12/26/2006
Last updated
10/04/2007
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