Provider Demographics
NPI:1699880526
Name:LUCAS, TIMOTHY H JR (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:H
Last Name:LUCAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SUPERIOR AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3664
Mailing Address - Country:US
Mailing Address - Phone:949-764-4500
Mailing Address - Fax:949-764-4499
Practice Address - Street 1:510 SUPERIOR AVE STE 290
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3664
Practice Address - Country:US
Practice Address - Phone:949-764-4500
Practice Address - Fax:949-764-4499
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444576207T00000X
WAML20007025207T00000X
OH35143269207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0469144Medicaid