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General NPI Number Information
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NPI Number | 1811266521
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Entity Type | Organization
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Legal Business Name | MEDRECORD
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Dates
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Enumeration Date | 12/26/2011
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Last Update Date | 12/26/2011
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Provider Practice Location Address
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Address Line | 22182 BARTON RD
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5033
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Country | US
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Telephone | 909-800-0025
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11118 C/O HAROLD LUKE MD
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-1118
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Country | US
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Telephone | 909-800-0025
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN
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Name | HAROLD POHANG LUKE
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Credential | MD
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Telephone | 909-800-0025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G24934
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License Number State | CA
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