Provider Demographics
NPI:1669470258
Name:HALL, LUTHER DANIEL (DO)
Entity Type:Individual
Prefix:
First Name:LUTHER
Middle Name:DANIEL
Last Name:HALL
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:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:120 N 3RD ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1574
Practice Address - Country:US
Practice Address - Phone:740-532-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2051729Medicaid
000000191985OtherBLUE CROSS BLUE SHIELD
KYP00430602OtherMEDICARE - RR
KY64024334Medicaid
KYP00430602OtherMEDICARE - RR
G23703Medicare UPIN
KY64024334Medicaid
KY0676502Medicare ID - Type UnspecifiedKY MEDICARE
KY64024334Medicaid
KY0586694Medicare PIN