Provider Demographics
NPI:1942697834
Name:LUKEFAHR, ASHLEY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:LUKEFAHR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:PO BOX 245108
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5108
Mailing Address - Country:US
Mailing Address - Phone:520-626-6830
Mailing Address - Fax:520-626-2521
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:BOX 245108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5108
Practice Address - Country:US
Practice Address - Phone:520-626-6830
Practice Address - Fax:520-626-2521
Is Sole Proprietor?:No
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR74905207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology