Individual
MR. LUKE LANCE KEENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SOIDC
Contact information
Practice address
MARSOC, PSC BOX 20073, CAMP LEJEUNE, NC 28542-0073
(910) 449-9967
Mailing address
3D MSOB, PSC BOX 20073, CAMP LEJEUNE, NC 28542-0073
(910) 449-9967
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265997380
SOIDC MILITARY
NC
Enumeration date
01/30/2015
Last updated
01/30/2015
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