Provider Demographics
NPI:1356382071
Name:LUTHER, J. SCOTT (MD)
Entity type:Individual
Prefix:
First Name:J. SCOTT
Middle Name:
Last Name:LUTHER
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 1:4410 MEDICAL DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3749
Mailing Address - Country:US
Mailing Address - Phone:210-615-8070
Mailing Address - Fax:210-615-6645
Practice Address - Street 1:4410 MEDICAL DR
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3749
Practice Address - Country:US
Practice Address - Phone:210-615-8070
Practice Address - Fax:210-615-6645
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG96162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L57KOtherBCBS PROVIDER ID
TX8CT354OtherBCBS
TX220515501Medicaid
TX00L57KMedicare PIN
TXC85247Medicare UPIN
TX220515501Medicaid