Provider Demographics
NPI:1891890075
Name:LUEDECKE, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:LUEDECKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 240098
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-0098
Mailing Address - Country:US
Mailing Address - Phone:210-621-0640
Mailing Address - Fax:210-621-2386
Practice Address - Street 1:12790 FM 1560 #755
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-2232
Practice Address - Country:US
Practice Address - Phone:210-614-3371
Practice Address - Fax:210-614-1055
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9758207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050045895OtherRAILROAD MEDICARE
TX128167705Medicaid
TX103527400OtherUSDOL
TX103527400OtherUSDOL
TX00R96AMedicare PIN