Basic Information
| Provider Information | |||||||||
| NPI: | 1225001472 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCKMAN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5431 N UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330674639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543442522 | ||||||||
| FaxNumber: | 9543449189 | ||||||||
| Practice Location | |||||||||
| Address1: | 8329 W SUNRISE BLVD | ||||||||
| Address2: | |||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333225405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546271617 | ||||||||
| FaxNumber: | 9544743489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 05/07/2019 | ||||||||
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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 | 207RG0100X | ME0016181 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.