1508291436 NPI number — LUCAS BINGHAM M.D., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508291436 NPI number — LUCAS BINGHAM M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCAS BINGHAM M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508291436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 CORPORATE DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LADERA RANCH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92694-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-388-8022
Provider Business Mailing Address Fax Number:
949-388-8033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 CORPORATE DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LADERA RANCH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-388-8022
Provider Business Practice Location Address Fax Number:
949-388-8033
Provider Enumeration Date:
09/11/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BINGHAM
Authorized Official First Name:
LUCAS
Authorized Official Middle Name:
GARDNER
Authorized Official Title or Position:
DERMATOLOGIST
Authorized Official Telephone Number:
801-830-7222

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  A104512 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)