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Organization

ERNEST A. LUCERO, MD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ERNEST ANTHONY LUCERO M.D. (PRESIDENT)
(208) 267-2086
Entity
Organization

Contact information

Practice address
6641 KANIKSU ST STE B, BONNERS FERRY, ID 83805-7532
(208) 267-2086
(208) 267-4013
Mailing address
6641 KANIKSU ST STE B, PO BOX 898, BONNERS FERRY, ID 83805-7532
(208) 267-2086
(208) 267-4013

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
M5577
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010003687
BLUE SHIELD OF IDAHO
ID
01
DA558
BLUE CROSS OF IDAHO
Enumeration date
12/04/2007
Last updated
12/04/2007
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