Basic Information
| Provider Information | |||||||||
| NPI: | 1205882636 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCAS | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ERIC | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6245 SHERIDAN DR | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142214834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162044500 | ||||||||
| FaxNumber: | 7162044501 | ||||||||
| Practice Location | |||||||||
| Address1: | 6245 SHERIDAN DR | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142214834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162044500 | ||||||||
| FaxNumber: | 7162044501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 010654-1 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.