MEDICARE: DR. JOHN CHARLES LUCKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35965	NC
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	38432	AL

General Provider Information

NPI Number	:	1316995301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN CHARLES LUCKE M.D.

Provider Business Mailing Address
First Line	:	380 WOODS COVE RD
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2428
Country	:	US
Telephone Number	:	256-259-4444
Fax Number	:	256-218-3536

Provider Business Practice Location Address
First Line	:	380 WOODS COVE RD
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2428
Country	:	US
Telephone Number	:	256-259-4444
Fax Number	:	256-218-3536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/13/2019

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