Individual
ALEXIS B DE LUCCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2020 SE 182ND AVENUE, GRESHAM, OR 97030
(503) 988-5400
(503) 988-5668
Mailing address
421 SW OAK ST, STE. 210, PORTLAND, OR 97204-1817
(503) 988-7468
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD175758
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
05
—
096511
—
OR
Enumeration date
05/07/2013
Last updated
12/19/2016
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