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General NPI Number Information
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NPI Number | 1225454614
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Entity Type | Individual
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Provider Name | VALAREE ALEXIS LUCK DO
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Gender | Female
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 240 MEETING HOUSE LN
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City | SOUTHAMPTON
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State | NY
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Zip | 11968
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Country | US
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Telephone | 631-726-0409
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Fax | 631-726-0396
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Provider Business Mailing Address
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Address Line | 1120 HOMESTEAD RD N
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-6044
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Country | US
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Telephone | 239-303-5020
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS15545
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License Number State | FL
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