Provider Demographics
NPI:1053345355
Name:LUCK, TEDFORD CLIVE (MD,)
Entity type:Individual
Prefix:DR
First Name:TEDFORD
Middle Name:CLIVE
Last Name:LUCK
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 1:1055 CLERMONT ST. 11B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-0809
Mailing Address - Country:US
Mailing Address - Phone:303-393-2839
Mailing Address - Fax:303-393-4677
Practice Address - Street 1:1055 CLERMONT ST. 11B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-0809
Practice Address - Country:US
Practice Address - Phone:303-393-2839
Practice Address - Fax:303-393-4677
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine