Individual
JACK I LU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101240453
VA
207R00000X
Internal Medicine Physician
Primary
D65008
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982717765
—
VA
01
—
P00417036
MEDICARE RAILROAD CARRIER
VA
Enumeration date
08/16/2006
Last updated
06/19/2018
Update your record
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