Individual
DR. GARY J LUCKASEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 E HARMONY RD, UNIT 100, FORT COLLINS, CO 80528-3401
(970) 221-1000
(970) 297-6860
Mailing address
2121 E HARMONY RD, SUITE 100, FORT COLLINS, CO 80528-3400
(970) 221-1000
(970) 297-6860
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
19652
NE
207RC0000X
Cardiovascular Disease Physician
Primary
20789
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01207893
—
CO
05
—
103400600
—
WY
01
—
P00910572
MEDICARE RAILROAD
CO
01
—
P00970356
MEDICARE RAILROAD
NE
Enumeration date
06/21/2005
Last updated
06/12/2014
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