Provider Demographics
NPI:1154312221
Name:LUTZ, THOMAS WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:LUTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 S WOODWORTH LOOP
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-8984
Mailing Address - Country:US
Mailing Address - Phone:907-861-6565
Mailing Address - Fax:907-861-6568
Practice Address - Street 1:4300 B ST STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5933
Practice Address - Country:US
Practice Address - Phone:907-375-3355
Practice Address - Fax:907-375-3351
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6052207R00000X, 208M00000X
MI5101013419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine