Individual
LUCAS RAY MOAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 COLLEGE RD, LEBANON, IL 62254-1291
(618) 232-7228
Mailing address
200 MASCOUTAH AVE APT 1, BELLEVILLE, IL 62220-3885
(618) 964-0210
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
IL
Other
Enumeration date
11/19/2025
Last updated
11/19/2025
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