Individual
DR. LUCAS ANISSIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4689 US HIGHWAY 17, FLEMING ISLAND, FL 32003-4831
(904) 269-7007
(904) 269-0529
Mailing address
1665 KINGSLEY AVE, SUITE 107, ORANGE PARK, FL 32073-4490
(904) 269-6565
(904) 269-0529
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
201054
LA
207X00000X
Orthopaedic Surgery Physician
Primary
ME111701
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1582956
—
LA
Enumeration date
07/11/2006
Last updated
06/27/2013
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