Basic Information
| Provider Information | |||||||||
| NPI: | 1891887576 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUKEFAHR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7703 FLOYD CURL DR | ||||||||
| Address2: | MC7977 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104509000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 315 N SAN SABA | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782073154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107043800 | ||||||||
| FaxNumber: | 2107043392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 11/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | F1764 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | 2080C0008X | F1764 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | Child Abuse Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 138379617 | 05 | TX | MEDICAID |