Provider Demographics
NPI:1407266059
Name:LUECKE, GWENDOLYN
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:LUECKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 RED RIVER ST
Mailing Address - Street 2:SUITE A1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1943
Mailing Address - Country:US
Mailing Address - Phone:512-324-7036
Mailing Address - Fax:
Practice Address - Street 1:1313 RED RIVER ST
Practice Address - Street 2:SUITE A1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1943
Practice Address - Country:US
Practice Address - Phone:512-324-7036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050221207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology