Healthcare Provider Details

I. General information

NPI: 1528565439
Provider Name (Legal Business Name): LUKE WILLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST
TACOMA WA
98405-4933
US

IV. Provider business mailing address

315 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-4234
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-4101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD215937
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD.MD.61554097
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: