Provider Demographics
NPI:1861493983
Name:LUKAVSKY, JAMES P SR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:LUKAVSKY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 BUSINESS PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616
Mailing Address - Country:US
Mailing Address - Phone:417-337-7511
Mailing Address - Fax:877-836-7836
Practice Address - Street 1:115 BUSINESS PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-337-7511
Practice Address - Fax:877-836-7836
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMD 36766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202238028Medicaid