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Organization
ERNEST A. LUCERO, MD PC
Active
Organization
ERNEST A. LUCERO, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST ANTHONY LUCERO M.D. (PRESIDENT)
(208) 267-2086
Entity
Organization
Contact information
Practice address
6641 KANIKSU ST STE B, BONNERS FERRY, ID 83805-7532
(208) 267-2086
(208) 267-4013
Mailing address
6641 KANIKSU ST STE B, PO BOX 898, BONNERS FERRY, ID 83805-7532
(208) 267-2086
(208) 267-4013
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
M5577
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010003687
BLUE SHIELD OF IDAHO
ID
01
—
DA558
BLUE CROSS OF IDAHO
—
Enumeration date
12/04/2007
Last updated
12/04/2007
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