Individual
ANCESLO IDICULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3601 4TH ST # MS 8312, LUBBOCK, TX 79430-0002
(806) 743-2373
(806) 743-4354
Mailing address
3601 4TH ST # MS 8312, LUBBOCK, TX 79430-0002
(806) 743-2373
(806) 743-4354
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
BP10052704
TX
2086S0105X
Surgery of the Hand (Surgery) Physician
Primary
U5988
TX
Other
Enumeration date
05/11/2015
Last updated
09/08/2023
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