Healthcare Provider Details

I. General information

NPI: 1831260884
Provider Name (Legal Business Name): EDGAR A. LUEG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 E MAIN ST STE 201
VENTURA CA
93003-2773
US

IV. Provider business mailing address

2660 E MAIN ST STE 201
VENTURA CA
93003-2773
US

V. Phone/Fax

Practice location:
  • Phone: 805-643-9999
  • Fax:
Mailing address:
  • Phone: 805-643-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA52915
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA52915
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberA52915
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA52915
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA52915
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberA52915
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA52915
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License NumberA52915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: