Provider Demographics
NPI:1093749293
Name:LUCKEY, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:LUCKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 NW 27TH WAY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1729
Mailing Address - Country:US
Mailing Address - Phone:954-861-6359
Mailing Address - Fax:734-293-8841
Practice Address - Street 1:6250 NW 27TH WAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1729
Practice Address - Country:US
Practice Address - Phone:954-861-6359
Practice Address - Fax:734-293-8841
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics