Derting, Lucas R

Derting, Lucas R is an individual health care provider with primary practice located at 1600 North Grand Avenue Suite 500, Pueblo CO 81003-2757. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Derting, Lucas R can be contacted via phone (719) 545-0663.

Contact Information

Primary practice address
1600 North Grand Avenue Suite 500 Pueblo CO 81003-2757
Phone: (719) 545-0663
Fax: (719) 595-7903
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1080 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 1080 Colorado

Profile Details

NPI number 1306846381
LBN Legal business name Derting, Lucas R
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2005
Last updated Nov 3rd, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306846381 NPPES
Colorado MEDICAID 63720345

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