Provider Demographics
NPI:1740414465
Name:YUHICO, LUKE SIMON OLIVERA (MD)
Entity Type:Individual
Prefix:
First Name:LUKE SIMON
Middle Name:OLIVERA
Last Name:YUHICO
Suffix:
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 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:PULMONOLOGY DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6796
Mailing Address - Country:US
Mailing Address - Phone:850-243-0118
Mailing Address - Fax:850-243-0594
Practice Address - Street 1:1005 MAR WALT DRIVE
Practice Address - Street 2:PULMONOLOGY DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6796
Practice Address - Country:US
Practice Address - Phone:850-243-0118
Practice Address - Fax:850-243-0594
Is Sole Proprietor?:No
Enumeration Date:2009-05-09
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125855207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSRQW6OtherBCBSFL
FL015897100Medicaid
FL015897100Medicaid