Provider Demographics
NPI:1366495251
Name:CHANNER, LUKE T (MD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:T
Last Name:CHANNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:1224 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2338
Mailing Address - Country:US
Mailing Address - Phone:406-375-4823
Mailing Address - Fax:406-363-2148
Practice Address - Street 1:215 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2328
Practice Address - Country:US
Practice Address - Phone:406-375-2930
Practice Address - Fax:406-375-4525
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT8380208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0107695Medicaid
G77104Medicare UPIN
MT0107695Medicaid