Provider Demographics
NPI:1174833669
Name:PAUL LUTHER MD, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PAUL LUTHER MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-809-6766
Mailing Address - Street 1:1663 DOMINICAN WAY
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1527
Mailing Address - Country:US
Mailing Address - Phone:831-809-6766
Mailing Address - Fax:
Practice Address - Street 1:1663 DOMINICAN WAY
Practice Address - Street 2:SUITE 214
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1527
Practice Address - Country:US
Practice Address - Phone:831-809-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0307582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307580Medicaid
CA00A307580Medicaid
00A307583Medicare PIN