Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101259983 | VA |
N | 2080P0204X | Pediatric Emergency Doctor | 25MA10545700 | NJ |
NPI | 1114319324 |
---|---|
Provider Name | Dr. James Thomas Luckey III |
First Address | Chesapeake, VA 23320-3098 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2015 |
Last Update Date | 29/04/2019 |