Provider Demographics
NPI:1902282692
Name:LUCKOOR, PAVAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:PAVAN
Middle Name:R
Last Name:LUCKOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3041 E FLAMINGO RD
Mailing Address - Street 2:STE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7447
Mailing Address - Country:US
Mailing Address - Phone:702-436-0835
Mailing Address - Fax:702-435-6212
Practice Address - Street 1:3041 E FLAMINGO RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7447
Practice Address - Country:US
Practice Address - Phone:562-677-2414
Practice Address - Fax:562-677-4479
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV19651207R00000X
AZ56526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine