Provider Demographics
NPI:1043579956
Name:LUECKER, CHARLES T (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:LUECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GALA STREET
Mailing Address - Street 2:QUEENS PARK
Mailing Address - City:INVERCARGILL
Mailing Address - State:SOUTHLAND
Mailing Address - Zip Code:9810
Mailing Address - Country:NZ
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 GALA STREET
Practice Address - Street 2:QUEENS PARK
Practice Address - City:INVERCARGILL
Practice Address - State:SOUTHLAND
Practice Address - Zip Code:9810
Practice Address - Country:NZ
Practice Address - Phone:643-214-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039380A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery