Individual
MR. ANTHONY JARED LUCCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
701 N 1ST ST, SPRINGFIELD, IL 62781-0001
(217) 788-3156
(217) 788-6459
Mailing address
1119 INTERLACKEN RD, SPRINGFIELD, IL 62704-2129
(217) 622-5975
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IL
Other
Enumeration date
02/18/2014
Last updated
02/18/2014
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