Individual
JOHN FAIR LUCAS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 W WASHINGTON ST, GREENWOOD, MS 38930-4237
(662) 453-4641
(662) 455-4731
Mailing address
501 W WASHINGTON ST, GREENWOOD, MS 38930-4237
(662) 453-4641
(662) 455-4731
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
09898
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00013434
—
MS
Enumeration date
07/19/2006
Last updated
07/08/2007
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