Provider Demographics
NPI:1295791069
Name:LUCIANI, GERALD DAN (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:DAN
Last Name:LUCIANI
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 1:4701 MEDICAL CENTER DR
Mailing Address - Street 2:STE 1-A
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1831
Mailing Address - Country:US
Mailing Address - Phone:214-733-8001
Mailing Address - Fax:972-542-3559
Practice Address - Street 1:4701 MEDICAL CENTER DR
Practice Address - Street 2:STE 1-A
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1831
Practice Address - Country:US
Practice Address - Phone:214-733-8001
Practice Address - Fax:972-542-3559
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8653207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167267702Medicaid
TXI15975Medicare UPIN
TX8F2100Medicare ID - Type Unspecified