Basic Information
| Provider Information | |||||||||
| NPI: | 1760561484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEORGE R LUCK M D P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 NE 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334413504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544268840 | ||||||||
| FaxNumber: | 9544266641 | ||||||||
| 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: | 11/03/2006 | ||||||||
| LastUpdateDate: | 10/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | LUCK | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9544268840 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD PA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | ME0054460 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | ME0054460 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 263024900 | 05 | FL | MEDICAID |