Provider Demographics
NPI:1376729855
Name:J. LUKE LENTZ, MD, PA
Entity type:Organization
Organization Name:J. LUKE LENTZ, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LUTHER
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:850-424-6841
Mailing Address - Street 1:737 HIGHWAY 98 E STE 1
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2538
Mailing Address - Country:US
Mailing Address - Phone:850-424-6841
Mailing Address - Fax:850-424-6845
Practice Address - Street 1:737 HIGHWAY 98 E STE 1
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2538
Practice Address - Country:US
Practice Address - Phone:850-424-6841
Practice Address - Fax:850-424-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82437261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD99264Medicare UPIN