Individual
LUCAS G BINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 CORPORATE DR, STE 100, LADERA RANCH, CA 92694-2106
(949) 388-8022
(949) 388-8033
Mailing address
600 CORPORATE DR, STE 100, LADERA RANCH, CA 92694-2106
(949) 388-8022
(949) 388-8033
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
36857
AZ
207N00000X
Dermatology Physician
47852
MN
207N00000X
Dermatology Physician
Primary
A104512
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265506
—
AZ
05
—
783850600
—
MN
01
—
860800150 85259 B201
TRICARE
AZ
01
—
P00425647
RAILROAD MEDICARE
AZ
Enumeration date
02/17/2006
Last updated
10/01/2014
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