Individual
PATRICIA MARION LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
359 MEDICAL GROUP, 221 THIRD STREET WEST BLDG 1040, JOINT BASE SAN ANTONIO-RANDOLPH, TX 78150
(210) 652-4279
Mailing address
359 MEDICAL GROUP, 221 3RD ST WEST BLDG 1040, JBSA-RANOLPH, TX 78150-4267
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1046215
GA
363AM0700X
Medical Physician Assistant
PA06993
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1046215
NCCPA
—
01
—
PA06993
STATE LICENSE
TX
Enumeration date
01/03/2006
Last updated
07/06/2018
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