Individual
JOHN C. LUCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2505 MISSION DR, SUITE 200, JEFFERSON CITY, MO 65109-9508
(573) 681-3759
(573) 681-3659
Mailing address
2505 MISSION DR, SUITE 200, JEFFERSON CITY, MO 65109-9508
(573) 681-3759
(573) 681-3659
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
109799
MO
208VP0014X
Interventional Pain Medicine Physician
Primary
109799
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050050621
RR MEDICARE
MO
05
—
248216806
—
MO
Enumeration date
09/20/2005
Last updated
12/15/2020
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