Provider Demographics
NPI:1235190067
Name:LAUCK, JAMES L JR (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:LAUCK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH STREET
Mailing Address - Street 2:STE 101
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101
Mailing Address - Country:US
Mailing Address - Phone:712-255-7474
Mailing Address - Fax:
Practice Address - Street 1:1600 7TH ST
Practice Address - Street 2:STE 101
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-2016
Practice Address - Country:US
Practice Address - Phone:712-255-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02805174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7767735Medicaid
NE10025457900Medicaid
P00361007OtherMEDICARE RAILROAD
IA1104604Medicaid
28656OtherWELLMARK BCBS OF IOWA
IAF67757Medicare UPIN
IAI9543Medicare ID - Type UnspecifiedMEDICARE B