Provider Demographics
NPI:1811100357
Name:LUKER, JERRY L
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:L
Last Name:LUKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W. 26TH ST STE. A
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114
Mailing Address - Country:US
Mailing Address - Phone:501-758-1017
Mailing Address - Fax:501-758-1031
Practice Address - Street 1:406 W 26TH ST STE A
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-2158
Practice Address - Country:US
Practice Address - Phone:501-758-1017
Practice Address - Fax:501-758-1031
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR35174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49964OtherBLUE CROSS BLUE SHIELD