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General NPI Number Information
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NPI Number | 1275690992
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Entity Type | Individual
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Provider Name | FREDERIC LUO MD
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 01/01/2025
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Provider Practice Location Address
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Address Line | 22707 S ELLSWORTH RD STE 105
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-6132
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Country | US
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Telephone | 480-888-1900
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Fax | 480-888-1934
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Provider Business Mailing Address
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Address Line | PO BOX 1108
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86405-1108
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 31254
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License Number State | AZ
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