Individual
LUCAS VANNOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1061 HARMON AVE STE 1D03, FORT STEWART, GA 31314-5674
(912) 435-5965
Mailing address
600 HIGHLAND AVE, MADISON, WI 53792-0001
(740) 525-5612
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
8152-851
WI
208D00000X
General Practice Physician
1350
NE
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/17/2014
Last updated
04/28/2022
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