Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 107013 | MN |
N | 207X00000X | Orthopaedic Surgeon | 2000156464 | MO |
Y | 207X00000X | Orthopaedic Surgeon | Q8291 | TX |
NPI | 1003856576 |
---|---|
Provider Name | Dean A Lusardi |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 11/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200039419 | RAILROAD MEDICARE (01) | |
205095102 | (05) | MO |
359244601 | (05) | TX |
359244602 | CSHCN (01) | TX |
505985YK00 | (02) | TX |
G38877 | (02) |