Basic Information
Provider Information
NPI: 1003017427
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LUE
FirstName: STANLEY
MiddleName: GARKEN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9110 COLLEGE POINTE CT
Address2:  
City: FORT MYERS
State: FL
PostalCode: 339193244
CountryCode: US
TelephoneNumber: 2392083323
FaxNumber: 2392083994
Practice Location
Address1: 9110 COLLEGE POINTE CT
Address2:  
City: FORT MYERS
State: FL
PostalCode: 33919
CountryCode: US
TelephoneNumber: 2392082212
FaxNumber: 2392083994
Other Information
ProviderEnumerationDate: 05/31/2007
LastUpdateDate: 11/06/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084N0400XMD127398FLY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X17836NHN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X292709NYN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400XN2178TXN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X29193NEN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X2016-00670NCN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400XMD60365989WAN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
2084N0400X4301114445MIN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
390200000XTRN8973FLN Student, Health CareStudent in an Organized Health Care Education/Training Program 

ID Information
IDTypeStateIssuerDescription
28438640105TX MEDICAID
28438640205TX MEDICAID
311576805NH MEDICAID
P0102975801TXRAILROADOTHER


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