Basic Information
| Provider Information | |||||||||
| NPI: | 1578557336 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAUCKS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 507 TIRE HILL ROAD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144674055 | ||||||||
| FaxNumber: | 8142544092 | ||||||||
| Practice Location | |||||||||
| Address1: | 1497A S. QUEEN STREET | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178483979 | ||||||||
| FaxNumber: | 7176688967 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 12/08/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD023729E | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LA0401X | MD023729E | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Addiction Medicine | 207LP2900X | MD023729E | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.