Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 779 | FL |
NPI | 1003174848 |
---|---|
Provider Name | Dr. Peter Marc Luckower |
First Address | North Miami, FL 33181-3404 |
Second Address | North Miami, FL 33181-3404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2012 |
Last Update Date | 30/04/2012 |