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General NPI Number Information
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NPI Number | 1740414465
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Entity Type | Individual
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Provider Name | LUKE SIMON OLIVERA YUHICO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/09/2009
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Last Update Date | 01/23/2017
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Provider Practice Location Address
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Address Line | 1005 MAR WALT DRIVE PULMONOLOGY DEPARTMENT
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6796
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Country | US
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Telephone | 850-243-0118
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Fax | 850-243-0594
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Provider Business Mailing Address
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Address Line | 1005 MAR WALT DRIVE PULMONOLOGY DEPARTMENT
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6796
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Country | US
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Telephone | 850-243-0118
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Fax | 850-243-0594
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | ME125855
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME125855
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License Number State | FL
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