1437135688 NPI number — MR. ABNER LYNN LUTHER MD

Table of content: MR. ABNER LYNN LUTHER MD (NPI 1437135688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437135688 NPI number — MR. ABNER LYNN LUTHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUTHER
Provider First Name:
ABNER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUTHER
Provider Other First Name:
A
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437135688
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 645
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOAZ
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35957-0645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-593-2840
Provider Business Mailing Address Fax Number:
256-593-2824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BOAZ
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-593-2840
Provider Business Practice Location Address Fax Number:
256-593-2824
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  5173 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000003851 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022510593 . This is a "RAILROAD CARE PALMETTO GB" identifier . This identifiers is of the category "OTHER".




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