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Mary Luckasen
General Practice Physician in Jbsa Ft Sam Houston, Texas
NPI 1366199754

Mary Luckasen is a General Practice Physician based in Jbsa Ft Sam Houston, TX. Mary Luckasen practices in Jbsa Ft Sam Houston, TX. The NPI Number for Mary Luckasen is 1366199754 and holds a License No. (Texas).

The current practice location address for Mary Luckasen is 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX and can be reached out via phone at 210-916-5910 and via fax at 210-916-2077.

Location: 3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX, 78234-4504
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1366199754
Provider Name
Mary Luckasen
Credential
Provider Entity Type
Individual
Gender
Female
Address
3551 Roger Brooke Dr, Jbsa Ft Sam Houston, TX, 78234-4504
Phone Number
210-916-5910
Fax Number
210-916-2077
Provider Enumeration Date
03/04/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
3551 Roger Brooke Dr
City
Jbsa Ft Sam Houston
State
Texas
Zip
78234-4504
Phone Number
210-916-5910
Fax Number
210-916-2077
person
Provider Business Mailing Address Details
Address
3551 Roger Brooke Dr
City
Jbsa Ft Sam Houston
State
Texas
Zip
78234-4504
Phone Number
210-916-5910
Fax Number
210-916-2077
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
171000000X
License No.
DR.0071968 (Colorado)
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
()
Definition
Definition to come...
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