Individual
MR. JOHN R LUCKASEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4242 FARNAM ST, STE 360, OMAHA, NE 68131-2850
(402) 552-2555
(402) 552-2573
Mailing address
4242 FARNAM ST, STE 360, OMAHA, NE 68131-2850
(402) 552-2555
(402) 552-2573
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
12194
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001967
BLUE SHIELD
SD
01
—
00686
BLUE SHIELD
NE
01
—
0300003
UNITED HEALTH CARE
NE
05
—
0918649
—
IA
01
—
139381XX
PREFERRED CARE
NE
05
—
47062325613
—
NE
01
—
501880
BLUE SHIELD
PA
05
—
7787680
—
SD
01
—
91864
BLUE SHIELD
IA
Enumeration date
06/13/2005
Last updated
07/09/2007
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