Healthcare Provider Details

I. General information

NPI: 1528016011
Provider Name (Legal Business Name): THOMAS WILLIAM LUCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4761 S. CLEVELAND AVE. SUITE 3
FORT MYERS FL
33907-1317
US

IV. Provider business mailing address

PO BOX 61557
FORT MYERS FL
33906-1557
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9722
  • Fax: 239-343-9725
Mailing address:
  • Phone: 239-245-5268
  • Fax: 239-343-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME78923
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME78923
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberME78923
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: