Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | LL1709 | SC |
Y | 207P00000X | Emergency Physician | Q8265 | TX |
NPI | 1013357920 |
---|---|
Provider Name | Luke Franklin Husby |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-4402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 09/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
367778304 | (05) | TX |
367778305 | CSHCN (01) | TX |