Provider Demographics
NPI:1851389803
Name:LUTHRA, CHAMAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAMAN
Middle Name:L
Last Name:LUTHRA
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 1:2325 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8316
Mailing Address - Country:US
Mailing Address - Phone:928-782-4319
Mailing Address - Fax:928-782-1632
Practice Address - Street 1:2325 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8316
Practice Address - Country:US
Practice Address - Phone:928-782-4319
Practice Address - Fax:928-782-1632
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10655207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ223363Medicaid
AZC99911Medicare UPIN
AZ0868340001Medicare NSC
AZ223363Medicaid