Provider Demographics
NPI:1194380683
Name:LUECK, BETHANY A (MD)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:A
Last Name:LUECK
Suffix:
Gender:
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:30 N MARIO CAPECCHI RM 2S100
Mailing Address - Street 2:400 W PUEBLO STREET
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112
Mailing Address - Country:US
Mailing Address - Phone:801-581-2121
Mailing Address - Fax:805-569-7317
Practice Address - Street 1:30 N MARIO CAPECCHI RM 2S100
Practice Address - Street 2:400 W PUEBLO STREET
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112
Practice Address - Country:US
Practice Address - Phone:801-581-2121
Practice Address - Fax:805-569-7317
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME149484208D00000X
UT14206966-12052085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice