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General NPI Number Information
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NPI Number | 1295964278
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Entity Type | Organization
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Legal Business Name | ST. LUKE'S PHYSICIAN GROUP, INC.
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 04/19/2010
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Provider Practice Location Address
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Address Line | 1601 W LIBERTY ST
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City | ALLENTOWN
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State | PA
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Zip | 18102-2071
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Country | US
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Telephone | 610-433-5228
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Fax | 610-433-4359
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Provider Business Mailing Address
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Address Line | 1601 W LIBERTY ST
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City | ALLENTOWN
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State | PA
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Zip | 18102
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Country | US
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Telephone | 610-433-5228
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Fax | 610-433-4359
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEAN W EVANS
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Credential |
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Telephone | 610-954-4991
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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 |
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License Number State | PA
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