Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2011039115 | MO |
Y | 2080A0000X | Adolescent Medicine | 27855 | NE |
NPI | 1083935522 |
---|---|
Provider Name | Luke Fletcher Anschutz |
First Address | Lincoln, NE 68505-3092 |
Second Address | Lincoln, NE 68522-1231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2010 |
Last Update Date | 06/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025151600 | (05) | NE |
10026369300 | (05) | NE |
47079049100 | (05) | NE |
47079049112 | (05) | NE |