MEDICARE: LENGS LUC JOSEPH MD

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	208D00000X	General Practice Physician	14	PR

General Provider Information

NPI Number	:	1649764333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENGS LUC JOSEPH MD

Provider Business Mailing Address
First Line	:	6820 SW 8TH ST
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-2513
Country	:	US
Telephone Number	:	954-793-8734
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 4055
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00605-4055
Country	:	US
Telephone Number	:	787-658-0000
Fax Number	:	787-819-0805

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

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	06/18/2018

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