Individual
DR. LUCAS ROSS WIEGAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
303 E PAR ST, ORLANDO, FL 32804-4003
(877) 876-3627
(321) 843-4101
Mailing address
303 E PAR ST, ORLANDO, FL 32804-4003
(877) 876-3627
(321) 843-4101
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
2011010512
MO
208800000X
Urology Physician
24854
WV
208800000X
Urology Physician
Primary
ME103855
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014458200
—
FL
01
—
14JR6
BLUE CROSS BLUE SHIELD
FL
01
—
3810023512
MEDICAID
WV
01
—
WV1425A
MEDICARE PTAN
WV
Enumeration date
10/25/2007
Last updated
08/18/2023
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