Basic Information
Provider Information | |||||||||
NPI: | 1790912244 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FERRER CARDONA | ||||||||
FirstName: | LUCAS | ||||||||
MiddleName: | MANUEL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FERRER | ||||||||
OtherFirstName: | LUCAS | ||||||||
OtherMiddleName: | M | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4502 MEDICAL DR | ||||||||
Address2: |   | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782294402 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2104509000 | ||||||||
FaxNumber: | 2104504903 | ||||||||
Practice Location | |||||||||
Address1: | 4502 MEDICAL DR | ||||||||
Address2: |   | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782294402 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2103582074 | ||||||||
FaxNumber: | 2103584779 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/11/2009 | ||||||||
LastUpdateDate: | 11/05/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | R8560 | TX | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 2086S0129X | R8560 | TX | Y |   | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
ID | Type | State | Issuer | Description | 388930502 | 01 | TX | CSHCN | OTHER | 388930501 | 05 | TX |   | MEDICAID |