Provider Demographics
NPI:1730478405
Name:LINDA ANN LUTZ, M.D.,P.A.
Entity Type:Organization
Organization Name:LINDA ANN LUTZ, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-828-2285
Mailing Address - Street 1:4505 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-1908
Mailing Address - Country:US
Mailing Address - Phone:214-828-2285
Mailing Address - Fax:
Practice Address - Street 1:4505 CHAPEL HILL RD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-1908
Practice Address - Country:US
Practice Address - Phone:214-828-2285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9553207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC18623Medicare UPIN