| Doctor Name: | JESSE LUCKETT |
| NPI Number: | 1629337555 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMT |
| License Number: | 7005 |
| Business Practice Address: | 52 Ne Fremont St Portland, OR - 972122027 |
| Business Phone Number: | 5033816636 |
| Business Fax Number: | |
| Mailing Address: | 52 Ne Fremont St, PORTLAND |
| State: | OR |
| Postal Code: | 972122027 |
| Phone Number: | 5033816636 |
| Fax Number: | |
| NPI Enumeration Date: | 05/12/2012 |
| NPI Last Update Date: | 05/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171W00000X |
| License Number: | 7005 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). |