Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0 | UT |
NPI | 1083117584 |
---|---|
Provider Name | Dr. Kevin Fluckiger |
First Address | Jbsa Lackland, TX 78236-9908 |
Second Address | Jbsa Lackland, TX 78236-9908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2018 |
Last Update Date | 19/10/2020 |