Provider Demographics
NPI:1821040056
Name:LUX, PETER M (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:LUX
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 1:10645 N ORACLE RD STE 121-284
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9387
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:803-291-5906
Practice Address - Street 1:15810 S 42ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7409
Practice Address - Country:US
Practice Address - Phone:312-635-0973
Practice Address - Fax:803-291-5906
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044982208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA197972OtherLABOR & INDUSTRIES
WA6740LUOtherREGENCE
WA8425712Medicaid
WA6740LUOtherREGENCE
WA8854196Medicare ID - Type Unspecified