Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 12539R | LA |
NPI | 1043201585 |
---|---|
Provider Name | Mrs. Celeste Childress Luke |
First Address | Marksville, LA 71351-3099 |
Second Address | Marksville, LA 71351-3099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 24/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1541184 | (05) | LA |
180034882 | RAILROAD MEDICARE (01) | LA |
185374602 | UNITED HEALTHCARE (01) | LA |
1948691 | (05) | LA |
721418139 | HUMANA (01) | LA |
721418139 | STATE GROUP BENEFITS (01) | LA |
9903808 | GEHA (01) | LA |
G69282 | (02) | LA |