Individual
LUCAS EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6702 GODFREY RD, GODFREY, IL 62035-2205
(618) 467-1540
Mailing address
4901 CROWN POINT PL APT A, ALTON, IL 62002-5073
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.007325
IL
Other
Enumeration date
01/26/2020
Last updated
01/26/2020
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