Provider Demographics
NPI:1992042121
Name:COLLETTE LUTTMER, MD, PC
Entity Type:Organization
Organization Name:COLLETTE LUTTMER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LUTTMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-244-2292
Mailing Address - Street 1:714 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1529
Mailing Address - Country:US
Mailing Address - Phone:541-244-2292
Mailing Address - Fax:541-244-1512
Practice Address - Street 1:714 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1529
Practice Address - Country:US
Practice Address - Phone:541-244-2292
Practice Address - Fax:541-244-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty