Individual
DR. LARRY LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
20 HOSPITAL DR, LOGAN, WV 25601-3452
(304) 831-1101
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
1915
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1061641
WORKERS COMP
WV
05
—
3000030001
—
WV
01
—
P00255866
MEDICARE RAILROAD
WV
Enumeration date
06/15/2006
Last updated
11/07/2007
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