Healthcare Provider Details

I. General information

NPI: 1477570141
Provider Name (Legal Business Name): F BROBSON LUTZ, JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 JENA ST
NEW ORLEANS LA
70115-6325
US

IV. Provider business mailing address

2622 JENA ST
NEW ORLEANS LA
70115-6325
US

V. Phone/Fax

Practice location:
  • Phone: 504-895-0361
  • Fax: 504-895-5631
Mailing address:
  • Phone: 504-895-0361
  • Fax: 504-895-5631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD012819
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: