Provider Demographics
NPI:1427227222
Name:LUCKMAN, FEISS AND SOFF, MD PA
Entity Type:Organization
Organization Name:LUCKMAN, FEISS AND SOFF, MD PA
Other - Org Name:WEST BROWARD GASTROENTEROLOGY AND INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-474-3262
Mailing Address - Street 1:201 NW 82ND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7808
Mailing Address - Country:US
Mailing Address - Phone:954-474-3262
Mailing Address - Fax:954-474-3489
Practice Address - Street 1:201 NW 82ND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7808
Practice Address - Country:US
Practice Address - Phone:954-474-3262
Practice Address - Fax:954-474-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
40570Medicare PIN