Provider Demographics
NPI:1700890308
Name:LUKER, JOHN ALONZO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALONZO
Last Name:LUKER
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 1:4029 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7927
Mailing Address - Country:US
Mailing Address - Phone:512-326-1141
Mailing Address - Fax:512-326-4444
Practice Address - Street 1:4029 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:SUITE 115
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7927
Practice Address - Country:US
Practice Address - Phone:512-326-1141
Practice Address - Fax:512-326-4444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2689208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122536902Medicaid
TXE2689OtherPHYSICIAN'S PERMIT
TXOOAB42Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX122536902Medicaid