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General NPI Number Information
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NPI Number | 1386899680
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Entity Type | Individual
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Provider Name | LUKE EDWIN BRACKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 1233 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82601-2926
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Country | US
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Telephone | 207-577-7201
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Fax |
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Provider Business Mailing Address
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Address Line | 5234 CHENEY LOOP
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City | CASPER
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State | WY
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Zip | 82609-3391
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Country | US
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Telephone | 205-585-6498
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 8976A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 5796
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License Number State | AZ
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