Provider Demographics
NPI:1477570141
Name:LUTZ, JR., F BROBSON (MD)
Entity Type:Individual
Prefix:DR
First Name:F
Middle Name:BROBSON
Last Name:LUTZ, JR.
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 1:2622 JENA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6325
Mailing Address - Country:US
Mailing Address - Phone:504-895-0361
Mailing Address - Fax:504-895-5631
Practice Address - Street 1:2622 JENA ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6325
Practice Address - Country:US
Practice Address - Phone:504-895-0361
Practice Address - Fax:504-895-5631
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD012819174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1146471Medicaid
LAE46405Medicare UPIN
LA53834B394Medicare PIN