Provider Demographics
NPI:1245694983
Name:CHARLES, LUTHER (PA, MD)
Entity type:Individual
Prefix:DR
First Name:LUTHER
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:PA, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5600
Mailing Address - Country:US
Mailing Address - Phone:561-502-6388
Mailing Address - Fax:
Practice Address - Street 1:14820 N CAVE CREEK RD STE 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4951
Practice Address - Country:US
Practice Address - Phone:833-242-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPPA266363AM0700X, 363AM0700X
AZ9229363A00000X
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No251B00000XAgenciesCase Management