Provider Demographics
NPI:1437135688
Name:LUTHER, ABNER LYNN (MD)
Entity Type:Individual
Prefix:MR
First Name:ABNER
Middle Name:LYNN
Last Name:LUTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A
Other - Middle Name:LYNN
Other - Last Name:LUTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:256-593-2824
Practice Address - Street 1:201 N MAIN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957
Practice Address - Country:US
Practice Address - Phone:256-593-2840
Practice Address - Fax:256-593-2824
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5173208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000003851Medicaid
022510593OtherRAILROAD CARE PALMETTO GB
022510593OtherRAILROAD CARE PALMETTO GB
AL000003851Medicare ID - Type Unspecified