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NPI Code Detail

MEDICARE: DR. PAVAN R LUCKOOR MD

MEDICARE: DR. PAVAN R LUCKOOR MD
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
1207R00000XInternal Medicine Physician19651NV

General Provider Information

NPI Number : 1902282692
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PAVAN R LUCKOOR MD
Provider Business Mailing Address
First Line : 3041 E FLAMINGO RD
Second Line : STE A
City : LAS VEGAS
State : NV
Zip : 89121-7447
Country : US
Telephone Number : 702-436-0835
Fax Number : 702-435-6212
Provider Business Practice Location Address
First Line : 3041 E FLAMINGO RD STE A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-7447
Country : US
Telephone Number : 562-677-2414
Fax Number : 562-677-4479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2015
Last Update Date : 01/29/2021

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