Provider Demographics
NPI:1962426882
Name:LUCKSINGER, GREGG H (MD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:H
Last Name:LUCKSINGER
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 1:4534 W GATE BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1470
Mailing Address - Country:US
Mailing Address - Phone:512-388-5717
Mailing Address - Fax:512-366-9575
Practice Address - Street 1:4534 W GATE BLVD STE 113
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1470
Practice Address - Country:US
Practice Address - Phone:512-388-5717
Practice Address - Fax:512-366-9575
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128222006Medicaid
TX128222007Medicaid
TX128222004Medicaid
TXH8222OtherTEXAS ID
TX85T411OtherBLUE CROSS/BLUE SHIELD TX
TX128222004Medicaid
TX8K9053Medicare PIN
TXE74408Medicare UPIN
TX8K9058Medicare PIN