Luke San, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101048599 Issued in VA

Practice address

202 Agee St
Farmville, VA 23901-2617

Phone

(434) 392-6143

Fax

(434) 392-3866

NPI assigned

Jun 26, 2006

Last updated

Jun 18, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southside Internal Medicine, PC

  • Health Maintenance Organization
  • Farmville, VA
  • NPI 1609065341
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213747200000",
    "number": "1558397877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 AGEE ST",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "239012617",
            "telephone_number": "434-392-6143",
            "fax_number": "434-392-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 AGEE ST",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "239012617",
            "telephone_number": "434-392-6143",
            "fax_number": "434-392-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAN",
        "first_name": "LUKE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2008-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101048599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005849632",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia A Runnells, CRNA
• S.a.Martin, Jr. OD PC
• Safe Harbor Retreat LLC
• Alexander P Samuel, M.D
• Barbara Ann San, P.T.
• Jeffrey Sargent, LPTA
• Brittany Williams Scott, LPC
• Lorna Murtland Secondi, LCSW
• Ben Selvan, MBBS
• Akash Shah, PT

• Internal Medicine Physician in Farmville, VA
• Providers in Farmville, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.