Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 14780 | TX |
NPI | 1013005487 |
---|---|
Provider Name | Dr. Ernest B Luce |
First Address | San Antonio, TX 78229-3900 |
Second Address | San Antonio, TX 78229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83Y620 | BLUE CROSS BLUE SHIELD (01) | |
U44539 | (02) |