Individual
DR. LUCAS LEE VAN WAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
598 GEIGER BLVD, BEAUFORT, SC 29904
(843) 228-7186
Mailing address
MARINE FIGHTER ATTACK SQUADRON 312, PSC BOX 66122, BEAUFORT, VA 29904
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
0102207551
VA
208D00000X
General Practice Physician
Primary
0102207551
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/13/2021
Last updated
02/16/2024
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