Provider Demographics
NPI:1518929587
Name:LUX, JEFFREY S (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:LUX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 JUSTICE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-325-3668
Mailing Address - Fax:318-325-4658
Practice Address - Street 1:2220 JUSTICE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-325-3668
Practice Address - Fax:318-325-4658
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD097R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA40937OtherBLUE CROSS
LA1391174Medicaid
LA6158700001Medicare NSC
T83325Medicare UPIN
LA1391174Medicaid