Basic Information
| Provider Information | |||||||||
| NPI: | 1649235151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCIO | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1121 N CENTRAL AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079331221 | ||||||||
| FaxNumber: | 4079330747 | ||||||||
| Practice Location | |||||||||
| Address1: | 1121 N CENTRAL AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | KISSIMMEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347414405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079331221 | ||||||||
| FaxNumber: | 4079330747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | ME54610 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | ME54610 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | ME54610 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 12472 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 372186800 | 05 | FL | MEDICAID | 103380 | 01 | FL | AVMED PROVIDER ID | OTHER | 4323220 | 01 | FL | AETNA PROVIDER ID | OTHER | 4800797 | 01 | FM | UHC PROVIDER ID | OTHER | 3816548001 | 01 | FL | CIGNA PROVIDER ID | OTHER |