Provider Demographics
NPI:1962427542
Name:LUTH, RAYMOND ALAN (CRNA)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ALAN
Last Name:LUTH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Mailing Address - Street 1:1621 S CARSON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-4215
Mailing Address - Country:US
Mailing Address - Phone:918-592-1989
Mailing Address - Fax:918-592-1877
Practice Address - Street 1:1120 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4012
Practice Address - Country:US
Practice Address - Phone:918-579-8344
Practice Address - Fax:918-579-1556
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2010-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKR0063392367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100782450BMedicaid
OK248426412Medicare ID - Type Unspecified