Provider Demographics
NPI:1184692881
Name:LUECKE, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:LUECKE
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:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:FORT DAVIS
Mailing Address - State:TX
Mailing Address - Zip Code:79734-0008
Mailing Address - Country:US
Mailing Address - Phone:432-426-3217
Mailing Address - Fax:432-426-3084
Practice Address - Street 1:1 MEMORIAL SQUARE
Practice Address - Street 2:
Practice Address - City:FORT DAVIS
Practice Address - State:TX
Practice Address - Zip Code:79734
Practice Address - Country:US
Practice Address - Phone:432-426-3217
Practice Address - Fax:432-426-3084
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4504207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8854M0Medicare PIN
TXE20063Medicare UPIN