Healthcare Provider Details

I. General information

NPI: 1265765309
Provider Name (Legal Business Name): DAVID L. LUKENS,D.O.,P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 YAKIMA AVE SUITE 304
TACOMA WA
98405-4499
US

IV. Provider business mailing address

1802 YAKIMA AVE SUITE 304
TACOMA WA
98405-4499
US

V. Phone/Fax

Practice location:
  • Phone: 253-572-7101
  • Fax: 253-572-9461
Mailing address:
  • Phone: 253-572-7101
  • Fax: 253-572-9461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP00000600
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOP00000600
License Number StateWA

VIII. Authorized Official

Name: DR. DAVID LEE LUKENS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 253-572-7101