Provider Demographics
NPI:1750511499
Name:PERRY, LUKE S (MD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:S
Last Name:PERRY
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 1:4212 RAVENNA PL
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4170
Mailing Address - Country:US
Mailing Address - Phone:303-564-1215
Mailing Address - Fax:
Practice Address - Street 1:UW HOSPITAL AND CLINICS
Practice Address - Street 2:600 HIGHLAND AVE, H4/831
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-263-0572
Practice Address - Fax:608-890-7127
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0052822207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO023902OtherKAISER COMMERCIAL NUMBER
CO29778069Medicaid
CO023902OtherKAISER COMMERCIAL NUMBER