Provider Demographics
NPI:1487662342
Name:LAUCKS, SAMUEL SIMON II (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:SIMON
Last Name:LAUCKS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-7500
Mailing Address - Fax:717-848-2074
Practice Address - Street 1:1601 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4630
Practice Address - Country:US
Practice Address - Phone:717-812-7500
Practice Address - Fax:717-848-2074
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027130E208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01303901OtherBLUE CROSS
PA0012163740002Medicaid
PA127981OtherBLUE SHIELD
PA001216374Medicaid
B37478Medicare UPIN
PA001216374Medicaid
PA01303901OtherBLUE CROSS
PA127981FLTMedicare PIN