Basic Information
| Provider Information | |||||||||
| NPI: | 1427212083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCORE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ELAINE STOVER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 S NATIONAL AVE | ||||||||
| Address2: | STE. 540 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173541500 | ||||||||
| FaxNumber: | 4173541505 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 N LINCOLN AVE | ||||||||
| Address2: | #G | ||||||||
| City: | MONETT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657081641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173541500 | ||||||||
| FaxNumber: | 4173541505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2008 | ||||||||
| LastUpdateDate: | 01/08/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2008017163 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.