Provider Demographics
NPI:1023233707
Name:LUTT, JOSEPH RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RANDALL
Last Name:LUTT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1715 IRON HORSE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-9617
Mailing Address - Country:US
Mailing Address - Phone:720-494-4700
Mailing Address - Fax:720-494-4706
Practice Address - Street 1:1840 FOLSOM ST STE 105
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5712
Practice Address - Country:US
Practice Address - Phone:720-494-4706
Practice Address - Fax:720-494-4706
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2025-03-20
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Provider Licenses
StateLicense IDTaxonomies
CO47481207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43779875Medicaid
COCO305806Medicare PIN