Individual
MR. MARK MATHEW LUCERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1000 36TH ST, VERO BEACH, FL 32960-4862
(772) 567-4311
Mailing address
PO BOX 644102, VERO BEACH, FL 32964-4102
(772) 562-3254
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9102527
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291673800
—
FL
01
—
P00253782
RR MEDICARE
FL
01
—
X1617
BLUE CROSS
FL
Enumeration date
02/22/2006
Last updated
07/08/2007
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