# MEDRECORD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811266521
- **Authorized official:** HAROLD POHANG LUKE MD (CHAIRMAN)
- **Authorized official phone:** (909) 800-0025

## Contact information

- **Practice address:** 22182 BARTON RD, GRAND TERRACE, CA 92313-5033
- **Practice address phone:** (909) 800-0025
- **Mailing address:** PO BOX 11118, C/O HAROLD LUKE MD, SAN BERNARDINO, CA 92423-1118
- **Mailing address phone:** (909) 800-0025

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | G24934 | CA | Yes |

## Other

- **Enumeration date:** 12/26/2011
- **Last updated:** 12/26/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G249341 | — | CA |