Organization
H.PEYTON LUCKETT, M.D., PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY P LUCKETT M.D. (PRESIDENT)
(903) 595-2211
Entity
Organization
Contact information
Practice address
700 OLYMPIC PLAZA CIR STE 503, TYLER, TX 75701-1952
(903) 595-2211
(903) 595-1397
Mailing address
700 OLYMPIC PLAZA CIR STE 503, TYLER, TX 75701-1952
(903) 595-2211
(903) 595-1397
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
E6130
TX
261QP2300X
Primary Care Clinic/Center
E6130
TX
Other
Enumeration date
08/28/2012
Last updated
10/04/2012
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