Provider Demographics
NPI:1073841037
Name:A LYNN LUTHER MDPC
Entity Type:Organization
Organization Name:A LYNN LUTHER MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABNER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-593-2840
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-0645
Mailing Address - Country:US
Mailing Address - Phone:256-593-2840
Mailing Address - Fax:
Practice Address - Street 1:201 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-1601
Practice Address - Country:US
Practice Address - Phone:256-593-2840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5173208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000003851Medicaid
AL000003851Medicare UPIN