Provider Demographics
NPI:1083675706
Name:LURIE, DAVID P (M D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:LURIE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5977
Mailing Address - Country:US
Mailing Address - Phone:423-929-3358
Mailing Address - Fax:423-929-0106
Practice Address - Street 1:106 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5977
Practice Address - Country:US
Practice Address - Phone:423-929-3358
Practice Address - Fax:423-929-0106
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD013367207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1083675706OtherNPI
TN1083675706Medicaid
TN3185528Medicaid
TN1083675706OtherNPI
TN1083675706Medicaid
TN3185528Medicaid