Provider Demographics
NPI:1174015416
Name:VANELLS, LUKE DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:DOUGLAS
Last Name:VANELLS
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 1:920 DOUG WHITE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4180
Mailing Address - Country:US
Mailing Address - Phone:843-848-4299
Mailing Address - Fax:843-497-0625
Practice Address - Street 1:920 DOUG WHITE DR STE 150
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4180
Practice Address - Country:US
Practice Address - Phone:843-848-4299
Practice Address - Fax:843-497-0625
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-02
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC239293390200000X
SC881592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program