Basic Information
| Provider Information | |||||||||
| NPI: | 1740414465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YUHICO | ||||||||
| FirstName: | LUKE SIMON | ||||||||
| MiddleName: | OLIVERA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1005 MAR WALT DRIVE | ||||||||
| Address2: | PULMONOLOGY DEPARTMENT | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502430118 | ||||||||
| FaxNumber: | 8502430594 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 MAR WALT DRIVE | ||||||||
| Address2: | PULMONOLOGY DEPARTMENT | ||||||||
| City: | FORT WALTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325476796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502430118 | ||||||||
| FaxNumber: | 8502430594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2009 | ||||||||
| LastUpdateDate: | 01/23/2017 | ||||||||
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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 | 207RC0200X | ME125855 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | ME125855 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | SRQW6 | 01 | FL | BCBSFL | OTHER | 015897100 | 05 | FL | MEDICAID |