Healthcare Provider Details

I. General information

NPI: 1245692698
Provider Name (Legal Business Name): LUTHER ST JAMES IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

500 JOSEPHINE LN APT 5105
MONTGOMERY AL
36117-6170
US

V. Phone/Fax

Practice location:
  • Phone: 334-747-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.43226
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number312051
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: