Provider Demographics
NPI:1649249053
Name:LUCK, MINDY (MD)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2004
Mailing Address - Country:US
Mailing Address - Phone:817-468-3255
Mailing Address - Fax:817-468-7823
Practice Address - Street 1:3201 MATLOCK RD STE 350
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2954
Practice Address - Country:US
Practice Address - Phone:817-468-3255
Practice Address - Fax:817-468-7823
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9329207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168551303Medicaid
TX8G3868Medicare ID - Type Unspecified
TX168551303Medicaid