Provider Demographics
NPI:1225014640
Name:LU, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:LU
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 1:925 ADELE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312
Mailing Address - Country:US
Mailing Address - Phone:360-782-0129
Mailing Address - Fax:
Practice Address - Street 1:925 ADELE AVE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-3521
Practice Address - Country:US
Practice Address - Phone:360-782-0129
Practice Address - Fax:360-377-8029
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033703207R00000X
CAA48401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine