Basic Information
| Provider Information | |||||||||
| NPI: | 1174577845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCK | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2930 NW 28TH TER | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334346005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612122542 | ||||||||
| FaxNumber: | 5612181969 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 MEADOWS RD | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334862304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613957100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 06/01/2009 | ||||||||
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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 | 207L00000X | ME0054460 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 263024900 | 05 | FL | MEDICAID |