Healthcare Provider Details

I. General information

NPI: 1700890308
Provider Name (Legal Business Name): JOHN ALONZO LUKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 S CAPITAL OF TEXAS HWY SUITE 115
AUSTIN TX
78704-7927
US

IV. Provider business mailing address

4029 S CAPITAL OF TEXAS HWY SUITE 115
AUSTIN TX
78704-7927
US

V. Phone/Fax

Practice location:
  • Phone: 512-326-1141
  • Fax: 512-326-4444
Mailing address:
  • Phone: 512-326-1141
  • Fax: 512-326-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberE2689
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: