Provider Demographics
NPI:1487693743
Name:LUCAS, AVIS J (PA)
Entity type:Individual
Prefix:MS
First Name:AVIS
Middle Name:J
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:950 N PORTER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6400
Mailing Address - Country:US
Mailing Address - Phone:405-329-0121
Mailing Address - Fax:405-292-6099
Practice Address - Street 1:950 N PORTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071
Practice Address - Country:US
Practice Address - Phone:405-329-0121
Practice Address - Fax:405-292-6099
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200048200AMedicaid
P00195026Medicare PIN
OK200048200AMedicaid
OK249435201Medicare ID - Type Unspecified