1285608414 NPI number — DR. GARY BRYAN LUKES OD

Table of content: MARY BATES RN (NPI 1003207549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285608414 NPI number — DR. GARY BRYAN LUKES OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUKES
Provider First Name:
GARY
Provider Middle Name:
BRYAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285608414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10
Provider Second Line Business Mailing Address:
344 E EAU GALLE RD
Provider Business Mailing Address City Name:
SPRING VALLEY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54767-9001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-778-5876
Provider Business Mailing Address Fax Number:
715-778-5874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 E EAU GALLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING VALLEY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54767-9001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-778-5876
Provider Business Practice Location Address Fax Number:
715-778-5874
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  1954 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1012515 . This is a "PREFERRED ONE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 92026LU . This is a "BC/BC/WI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 92028VA . This is a "BC/BS/WI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 18235 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 2210848 . This is a "MEDICA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 391448892 . This is a "NVA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: W2913 300 . This is a "SELECT CARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 385-22-700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com