Provider Demographics
NPI:1265765309
Name:DAVID L. LUKENS,D.O.,P.S.
Entity type:Organization
Organization Name:DAVID L. LUKENS,D.O.,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LUKENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-572-7101
Mailing Address - Street 1:1802 YAKIMA AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4499
Mailing Address - Country:US
Mailing Address - Phone:253-572-7101
Mailing Address - Fax:253-572-9461
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-572-7101
Practice Address - Fax:253-572-9461
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID L. LUKENS, D.O.,P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000600208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty