Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1093749293 |
---|---|
Provider Name | Jeff Luckey |
First Address | Fort Lauderdale, FL 33309-1729 |
Second Address | Fort Lauderdale, FL 33309-1729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 25/11/2011 |