Provider Demographics
NPI:1760499412
Name:LUKEN, GARY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:LUKEN
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 1:325 W MONTGOMERY CROSS RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3309
Mailing Address - Country:US
Mailing Address - Phone:888-878-6886
Mailing Address - Fax:
Practice Address - Street 1:325 WEST MONTGOMERY CROSS ROAD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5641
Practice Address - Country:US
Practice Address - Phone:208-989-0813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0201750OtherAZ BLUECROSS AND BLUESHIELD
AZ020537Medicaid
AZHSZ134Medicare PIN
AZB33940Medicare UPIN
AZ020537Medicaid