Provider Demographics
NPI:1770560179
Name:JOHANSEN, LUTHER BRENT (MD)
Entity type:Individual
Prefix:DR
First Name:LUTHER
Middle Name:BRENT
Last Name:JOHANSEN
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:U.S. ARMY HOSPITAL
Mailing Address - Street 2:ATTN:MCEUL-PSY
Mailing Address - City:LANDSTUHL/KIRCHBERG
Mailing Address - State:RHINELAND-PFALZ
Mailing Address - Zip Code:66849
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U.S. ARMY HOSPITAL
Practice Address - Street 2:ATTN:MCEUL-PSY
Practice Address - City:LANDSTUHL/KIRCHBERG
Practice Address - State:RHINELAND-PFALZ
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:01149637-186-7276
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD410652084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry