Healthcare Provider Details

I. General information

NPI: 1104387026
Provider Name (Legal Business Name): LUTHER FLEURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 14TH ST SW
LARGO FL
33770-3133
US

IV. Provider business mailing address

201 14TH ST SW
LARGO FL
33770-3133
US

V. Phone/Fax

Practice location:
  • Phone: 561-633-3205
  • Fax:
Mailing address:
  • Phone: 561-633-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME172231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: