Individual
JEREMY TYLER LUCZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5151 E BROADWAY RD STE 107, MESA, AZ 85206-1346
(480) 290-7000
(602) 254-6840
Mailing address
5151 E BROADWAY RD STE 107, MESA, AZ 85206-1346
(480) 290-7000
(602) 254-6840
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11426
AZ
Other
Enumeration date
06/03/2024
Last updated
03/16/2026
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