Basic Information
| Provider Information | |||||||||
| NPI: | 1013353895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLUCK | ||||||||
| FirstName: | PHILIBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CWS, FACCWS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8360 | ||||||||
| Address2: | |||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008011360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407142845 | ||||||||
| FaxNumber: | 3407142843 | ||||||||
| Practice Location | |||||||||
| Address1: | 9149 ESTATE THOMAS | ||||||||
| Address2: | STE 104 | ||||||||
| City: | ST THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 008022615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3407142845 | ||||||||
| FaxNumber: | 3407142843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2013 | ||||||||
| LastUpdateDate: | 05/20/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | Other Service Providers | Specialist |
No ID Information.