Lucero, Mark Mathew

Lucero, Mark Mathew is an individual health care provider with primary practice located at 1000 36Th St , Vero Beach FL 32960-4862. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Lucero, Mark Mathew can be contacted via phone (772) 567-4311.

Contact Information

Primary practice address
1000 36Th St Vero Beach FL 32960-4862
Phone: (772) 567-4311
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9102527 Florida

Profile Details

NPI number 1730154790
LBN Legal business name Lucero, Mark Mathew
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 22nd, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730154790 NPPES
Florida Other P00253782 RR MEDICARE
Florida Other X1617 RR MEDICARE
Florida MEDICAID 291673800 RR MEDICARE

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