LUCAS R DERTING (NPI# 1306846381) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306846381 |
| Entity Type | Individual |
| Full Name | LUCAS R DERTING |
| Credential | PA-C |
| Practice Address |
1600 North Grand Avenue Suite 500 Pueblo CO 81003-2757 |
| Mailing Address |
Po Box 560825 Denver CO 80256-0825 |
| Practice Telephone | 7195450663 |
| Practice Fax Number | 7195957903 |
| Mailing Telephone | 7195957580 |
| Mailing Fax Number | 7195450176 |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2016-11-03 |
| NPI Deactivation Date | 03/22/2006 |
| NPI Reactivation Date | 2006-04-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1080 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
1080 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 63720345 | 05 |
| Street Address |
1600 NORTH GRAND AVENUE SUITE 500 |
| City | PUEBLO |
| State | CO |
| Zip Code | 81003-2757 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780667972 | Robert Nichols Alsever | Internal Medicine | 1600 North Grand Avenue, Suite 150, Pueblo, CO 81003-2755 | 2005-11-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164042016 | Sunil Kumar | Student in an Organized Health Care Education/Training Program | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2020-04-21 |
| 1497382303 | Pueblo Family Dentistry Pllc | Dentist | 701 N Grand Avenue, Suite B, Pueblo, CO 81003 | 2020-03-23 |
| 1023654241 | Elmer A. Villalon, Dmd, LLC | Clinic/Center | 1225 North Main Street, #207, Pueblo, CO 81003 | 2019-11-22 |
| 1518434349 | Mariam Rahim | Internal Medicine | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-10-30 |
| 1003308222 | Julia Mcneice | Internal Medicine | Parkview Medial Center, Parkveiw Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-06-04 |
| 1689164857 | Jessica Sels | Internal Medicine | Parkview Medical Center Adult Medicine Clinic, 311 W 14th St, Pueblo, CO 81003 | 2018-05-14 |
| 1700313459 | Allison Vigil | Occupational Therapist | 1600 W. 24th St, Pueblo, CO 81003 | 2017-05-12 |
| 1245682020 | Paul S Bongat | Internal Medicine | 411 W. 14th St., Parkview Adult Medicine Clinic, Pueblo, CO 81003 | 2016-07-06 |
| 1013368596 | Daniel R Long | Internal Medicine | 411 West 14th Street, Pueblo, CO 81003 | 2016-06-27 |
| 1396195665 | Parkview Medical Center | General Acute Care Hospital | 411 W. 14th St, Pueblo, CO 81003 | 2016-06-17 |
| Find all providers in zip 81003 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114527652 | Li Ashley Lim | Physician Assistant | 132 W B St Apt 3k, Pueblo, CO 81003-3446 | 2020-10-26 |
| 1104366178 | Alfe Garperio | Physician Assistant | 2625 W Pueblo Blvd, Pueblo, CO 81004-3816 | 2017-02-24 |
| 1871895995 | A Theodore Smith | Physician Assistant | 1600 West 24th Street, Colorado Mental Health Institute At Pueblo, Pueblo, CO 81003 | 2010-11-22 |
| 1689793812 | Paul Whitney Safford | Physician Assistant | 600 West 16th St, Pueblo, CO 81003 | 2007-03-28 |
| 1740347996 | Jose Luis Ramirez | Physician Assistant | 45825 Highway 96 East, Pueblo, CO 81006 | 2007-01-03 |
| 1932217635 | Juliana Schrettner | Physician Assistant | 1600 N Greenwood, 520, Pueblo, CO 81003 | 2006-08-25 |
| 1427046077 | James L Kramer | Physician Assistant | 1008 Minnegua Ave, Emergency Room, Pueblo, CO 81004 | 2005-10-07 |
| 1922001700 | Stephen D Bast | Physician Assistant | 3676 Parker Blvd, Pueblo, CO 81008-2212 | 2005-05-24 |
| 1245863257 | Anna Elizabeth Inserra | Physician Assistant | 1315 Fortino Blvd, Pueblo, CO 81008-1981 | 2020-02-18 |
| 1578121810 | Samuel Joseph Taibi | Physician Assistant | 300 Colorado Ave, Pueblo, CO 81004-2006 | 2019-06-02 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.