Healthcare Provider Details

I. General information

NPI: 1851664098
Provider Name (Legal Business Name): JASON LUTTRELL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/12/2024
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2699 LEE RD STE 320
WINTER PARK FL
32789-1740
US

IV. Provider business mailing address

1217 WOODMERE DR
ALTAMONTE SPRINGS FL
32714-2851
US

V. Phone/Fax

Practice location:
  • Phone: 321-356-1258
  • Fax: 407-329-3294
Mailing address:
  • Phone: 321-356-1258
  • Fax: 407-329-3294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 3540
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: