Provider Demographics
NPI:1578557336
Name:LAUCKS, STEPHEN O (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:O
Last Name:LAUCKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 TIRE HILL ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-467-4055
Mailing Address - Fax:814-254-4092
Practice Address - Street 1:1497A S. QUEEN STREET
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403
Practice Address - Country:US
Practice Address - Phone:717-848-3979
Practice Address - Fax:717-668-8967
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023729E207L00000X, 207LA0401X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004083Medicare PIN
B30019Medicare UPIN