Individual
DAVID GRANT LUKOMSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
721 RIVER DR STE C, FORT BRAGG, CA 95437
(707) 961-4995
Mailing address
931 W GREAT BASIN DR, MERIDIAN, ID 83646-4574
(208) 724-9391
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60459
CA
Other
Enumeration date
12/10/2021
Last updated
12/10/2021
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