Provider Demographics
NPI:1124193693
Name:LUTTON, ROBERT
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:LUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:RHONA
Other - Middle Name:
Other - Last Name:LUTTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2908 E ENID AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-4726
Mailing Address - Country:US
Mailing Address - Phone:480-641-5666
Mailing Address - Fax:
Practice Address - Street 1:2908 E ENID AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4726
Practice Address - Country:US
Practice Address - Phone:480-641-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5822385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ789662OtherAHCCCS ID NUMBER