Healthcare Provider Details

I. General information

NPI: 1962429308
Provider Name (Legal Business Name): CAMERON LUECK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

5053 SOUNDSIDE DR
GULF BREEZE FL
32563-8921
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-6670
  • Fax: 850-416-4694
Mailing address:
  • Phone: 850-416-6670
  • Fax: 850-416-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberPA9101306
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: