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NPI Code Detail

MEDICARE: LUCA LACKORE PAC

MEDICARE: LUCA LACKORE PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA13650TX

General Provider Information

NPI Number : 1003435785
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCA LACKORE PAC
Provider Business Mailing Address
First Line : 5732 CARUTH BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75209-3534
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4401 BOOTH CALLOWAY RD
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-7371
Country : US
Telephone Number : 817-255-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2020
Last Update Date : 03/04/2026

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