Provider Demographics
NPI:1063695831
Name:LU, LUIS WASHINGTON (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:WASHINGTON
Last Name:LU
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 1:504 W HARMONY PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5137
Mailing Address - Country:US
Mailing Address - Phone:814-594-6868
Mailing Address - Fax:
Practice Address - Street 1:845 E WARNER RD STE 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1058
Practice Address - Country:US
Practice Address - Phone:480-590-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026362E207W00000X
AZ40125207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RR9426OtherRAILROAD MEDICARE
RR9426OtherRAILROAD MEDICARE