Healthcare Provider Details

I. General information

NPI: 1184651820
Provider Name (Legal Business Name): TOM F. LUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE SUITE A610
SAN FRANCISCO CA
94143-0738
US

IV. Provider business mailing address

400 PARNASSUS AVENUE SUITE A610
SAN FRANCISCO CA
94143-0738
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2200
  • Fax: 415-353-2480
Mailing address:
  • Phone: 415-476-1611
  • Fax: 415-476-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA33382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: