Provider Demographics
NPI:1104148980
Name:LUKER, GREGG ANTHONY (HIS)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:ANTHONY
Last Name:LUKER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11334 W MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-9218
Mailing Address - Country:US
Mailing Address - Phone:623-936-8575
Mailing Address - Fax:
Practice Address - Street 1:11334 W MIAMI AVE
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-9218
Practice Address - Country:US
Practice Address - Phone:623-936-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR600237700000X
AZHADR10604237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist