# ERNEST A. LUCERO, MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912189697
- **Authorized official:** DR. ERNEST ANTHONY LUCERO M.D. (PRESIDENT)
- **Authorized official phone:** (208) 267-2086

## Contact information

- **Practice address:** 6641 KANIKSU ST STE B, BONNERS FERRY, ID 83805-7532
- **Practice address phone:** (208) 267-2086
- **Practice address fax:** (208) 267-4013
- **Mailing address:** 6641 KANIKSU ST STE B, PO BOX 898, BONNERS FERRY, ID 83805-7532
- **Mailing address phone:** (208) 267-2086
- **Mailing address fax:** (208) 267-4013

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | M5577 | ID | Yes |

## Other

- **Enumeration date:** 12/04/2007
- **Last updated:** 12/04/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010003687 | BLUE SHIELD OF IDAHO | ID |
| 01 | — | DA558 | BLUE CROSS OF IDAHO | — |