Provider Demographics
NPI:1043493950
Name:FREDERIC LUO, MD, MSEE, INC
Entity Type:Organization
Organization Name:FREDERIC LUO, MD, MSEE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:
Authorized Official - Last Name:LUO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-888-1900
Mailing Address - Street 1:1801 MESQUITE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5664
Mailing Address - Country:US
Mailing Address - Phone:480-888-1900
Mailing Address - Fax:480-888-1934
Practice Address - Street 1:1801 MESQUITE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5664
Practice Address - Country:US
Practice Address - Phone:480-888-1900
Practice Address - Fax:480-888-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31254207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty