Provider Demographics
NPI:1831273218
Name:C WILLIAM LUTTON MD PC
Entity type:Organization
Organization Name:C WILLIAM LUTTON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-683-3702
Mailing Address - Street 1:333 S 38TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4937
Mailing Address - Country:US
Mailing Address - Phone:918-683-3702
Mailing Address - Fax:918-683-3683
Practice Address - Street 1:333 S 38TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4937
Practice Address - Country:US
Practice Address - Phone:918-683-3702
Practice Address - Fax:918-683-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK183842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200094350AMedicaid
OK281461247Medicare PIN
OK200094350AMedicaid
OKCD3378Medicare PIN