Provider Demographics
NPI:1760453575
Name:LUCKIE, URIEL ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:URIEL
Middle Name:ROSS
Last Name:LUCKIE
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 1:629 N 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-4413
Mailing Address - Country:US
Mailing Address - Phone:850-453-4114
Mailing Address - Fax:850-505-6619
Practice Address - Street 1:6000 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0001
Practice Address - Country:US
Practice Address - Phone:850-505-6826
Practice Address - Fax:850-505-6619
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine