Provider Demographics
NPI:1639549439
Name:LUTE, JOSH (PA-C)
Entity type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:LUTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 S MCCLELLAN ST STE 118
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2446
Practice Address - Country:US
Practice Address - Phone:509-838-7100
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA2388363A00000X
WAPA60681685363A00000X
IDPT2388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant