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General NPI Number Information
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NPI Number | 1538168075
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Entity Type | Individual
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Provider Name | WILLIAM DAVID LUCKY SR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 125 NE 8TH ST SUITE 4
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City | HOMESTEAD
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State | FL
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Zip | 33030-4676
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Country | US
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Telephone | 305-238-3990
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Fax | 305-254-6331
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Provider Business Mailing Address
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Address Line | 13727 SW 152ND ST #104
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City | MIAMI
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State | FL
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Zip | 33177-1106
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Country | US
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Telephone | 305-238-3990
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Fax | 305-254-6331
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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 | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | ME29049
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0029049
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License Number State | FL
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