Provider Demographics
NPI:1225288749
Name:DR. LU FAMILY MEDICINE PROF. LLC
Entity Type:Organization
Organization Name:DR. LU FAMILY MEDICINE PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HONGLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-241-1370
Mailing Address - Street 1:2525 N 8TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8808
Mailing Address - Country:US
Mailing Address - Phone:970-241-1370
Mailing Address - Fax:
Practice Address - Street 1:2525 N 8TH ST STE 104
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8808
Practice Address - Country:US
Practice Address - Phone:970-241-1370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4416Medicare PIN