Provider Demographics
NPI:1851384143
Name:LUTHER, GORDON ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:ELLIOT
Last Name:LUTHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GORDON
Other - Middle Name:ELLIOT
Other - Last Name:HANNIGAN-LUTHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1593 E POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5326
Mailing Address - Country:US
Mailing Address - Phone:208-262-2300
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:750 N SYRINGA ST STE 100
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5275
Practice Address - Country:US
Practice Address - Phone:208-262-2600
Practice Address - Fax:208-262-2700
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7856207P00000X
IDM-7856207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDHBMT8OtherBLUE CROSS
ID805494100Medicaid
IDHBMT8OtherBLUE CROSS
ID1126613Medicare ID - Type UnspecifiedMEDICARE