Provider Demographics
NPI:1437184660
Name:LUTHER, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LUTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 DOMINICAN WAY STE 214
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1556
Mailing Address - Country:US
Mailing Address - Phone:831-713-5011
Mailing Address - Fax:831-713-5126
Practice Address - Street 1:1663 DOMINICAN WAY STE 214
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1556
Practice Address - Country:US
Practice Address - Phone:831-713-5011
Practice Address - Fax:831-713-5126
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA307582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A307580Medicaid
CAZZZ91891ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CAA30758OtherMEDICAL LICENSE#
CAZZZ91892ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CAZZZ92069ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CAZZZ92069ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP PTAN#
CA00A307580Medicaid