Basic Information
| Provider Information | |||||||||
| NPI: | 1083846679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VINCENT A LUCY MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25490 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968250490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085360300 | ||||||||
| FaxNumber: | 8085360320 | ||||||||
| Practice Location | |||||||||
| Address1: | 1319 PUNAHOU ST | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968261001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085360300 | ||||||||
| FaxNumber: | 8085360320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2009 | ||||||||
| LastUpdateDate: | 08/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | LUCY | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8083427792 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP3000X | 12056 | HI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology |
No ID Information.