Healthcare Provider Details

I. General information

NPI: 1366716516
Provider Name (Legal Business Name): JOHN A LUKER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 S CAPITAL OF TEXAS HWY STE 115
AUSTIN TX
78704-7920
US

IV. Provider business mailing address

4029 S CAPITAL OF TEXAS HWY STE 115
AUSTIN TX
78704-7920
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 Code314000000X
TaxonomySkilled Nursing Facility
License NumberE2689
License Number StateTX

VIII. Authorized Official

Name: DR. JOHN A LUKER
Title or Position: DOCTOR
Credential: MD PA
Phone: 512-326-1141