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General NPI Number Information
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NPI Number | 1093749293
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Entity Type | Individual
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Provider Name | JEFF LUCKEY
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 11/25/2011
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Provider Practice Location Address
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Address Line | 6250 NW 27TH WAY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1729
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Country | US
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Telephone | 954-861-6359
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Fax | 734-293-8841
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Provider Business Mailing Address
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Address Line | 6250 NW 27TH WAY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1729
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Country | US
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Telephone | 954-861-6359
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Fax | 734-293-8841
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number |
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License Number State |
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