Provider Demographics
NPI:1336463108
Name:O'ROURKE, LUKE WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:WILLIAM
Last Name:O'ROURKE
Suffix:
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 1:2990 CORTEZ AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7554
Mailing Address - Country:US
Mailing Address - Phone:208-535-0440
Mailing Address - Fax:208-535-0550
Practice Address - Street 1:2990 CORTEZ AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7554
Practice Address - Country:US
Practice Address - Phone:208-535-0440
Practice Address - Fax:208-535-0550
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO166693207V00000X
IDO-1563207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500673955Medicaid
R175693Medicare PIN