Provider Demographics
NPI:1649271677
Name:LUEKEN, ROBERT J (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:LUEKEN
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 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-531-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234866207PE0005X
TXP3761207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308101004Medicaid
TX75-0818167-048OtherTRICARE
TXP01118262OtherRAIL ROAD
TX308101001Medicaid
TX75-2616977-001OtherTRICARE
TX8AM874OtherBCBS
TX8DL528OtherBCBS
TX75-0818167-015OtherTRICARE
TX308101002Medicaid
TX308101003Medicaid
TX75-0818167-022OtherTRICARE
TX75-1976930-005OtherTRICARE
TX75-2616977-028OtherTRICARE
TX8DU478OtherBCBS
TX75-0818167-044OtherTRICARE
TX8DL531OtherBCBS
VA0101234866OtherMEDICINE AND SURGERY
TX75-2616977-002OtherTRICARE
TXP01118234OtherRAIL ROAD
TXP01304443OtherRAIL ROAD
TX308101003Medicaid
TX308101002Medicaid
TXTXB164325Medicare PIN
TX75-2616977-028OtherTRICARE