Healthcare Provider Details

I. General information

NPI: 1487249199
Provider Name (Legal Business Name): ALEX LUKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17122 DARIEN WING
SAN ANTONIO TX
78247-5835
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
JBSA FSH TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 801-800-3302
  • Fax:
Mailing address:
  • Phone: 210-916-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35200
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: