Healthcare Provider Details

I. General information

NPI: 1114909397
Provider Name (Legal Business Name): LUTHER PERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 S RIDGECREST AVE
RUTHERFORDTON NC
28139-2838
US

IV. Provider business mailing address

131 W 2ND ST PO BOX 886
RUTHERFORDTON NC
28139-2448
US

V. Phone/Fax

Practice location:
  • Phone: 828-395-1814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01053305A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2006-00367
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: