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NPI Code Detail

MEDICARE: BRADLEY JOHNSON LUTTRELL MD

MEDICARE: BRADLEY JOHNSON LUTTRELL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology PhysicianMD0000038353TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508850298
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY JOHNSON LUTTRELL MD
Provider Business Mailing Address
First Line : 90 VERMONT AVE
Second Line :
City : OAK RIDGE
State : TN
Zip : 37830-6478
Country : US
Telephone Number : 865-482-8890
Fax Number : 865-482-7400
Provider Business Practice Location Address
First Line : 90 VERMONT AVE
Second Line :
City : OAK RIDGE
State : TN
Zip : 37830-6478
Country : US
Telephone Number : 865-482-8890
Fax Number : 865-482-7400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 07/08/2007

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Directions to “ BRADLEY JOHNSON LUTTRELL MD” Practice Location

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