Provider Demographics
NPI:1023048725
Name:LUNKE, ROGER J (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:J
Last Name:LUNKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2833 BABCOCK RD STE 435
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4850
Mailing Address - Country:US
Mailing Address - Phone:210-705-5060
Mailing Address - Fax:210-705-5171
Practice Address - Street 1:2833 BABCOCK RD STE 435
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4850
Practice Address - Country:US
Practice Address - Phone:210-705-5060
Practice Address - Fax:210-705-5171
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4934207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123411404Medicaid
TXC18618Medicare UPIN