Healthcare Provider Details

I. General information

NPI: 1336646652
Provider Name (Legal Business Name): JOHN P LUCKETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 HENNESSY BLVD STE 3000
BATON ROUGE LA
70808-9183
US

IV. Provider business mailing address

7777 HENNESSY BLVD STE 3000
BATON ROUGE LA
70808-9183
US

V. Phone/Fax

Practice location:
  • Phone: 225-766-7441
  • Fax:
Mailing address:
  • Phone: 225-766-7441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number38447
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number340989
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: